Barking Mad: Being critical does not mean being biased

Marketplace turned its attention to the high cost of pet care, and questioned some common practices. That caused quite a few vets and animal health professionals to question the fairness of the piece. Dr. Morris Samson, a Toronto practitioner and Hospital Director of the Kingston Road Animal Hospital asked for a review. I considered the investigation tough but fair.

COMPLAINT

You are the hospital director at Vets Toronto and Kingston Road Animal Hospital in Toronto. You were very concerned and critical of the Marketplace episode entitled Barking Mad, aired on CBC on October 4, 2013. You also began a petition on your website to “stop the defamation of veterinarians.” You considered the documentary to be seriously “flawed and biased.” You are concerned that it had a negative impact on the entire profession and all its practitioners: “It was one sided for sensationalism, and aired like a tabloid magazine for content.”

You were one of over a dozen complainants about this story. The broadcast featured the results of undercover visits to ten veterinarians in the Toronto area. Host Erica Johnson discovered discrepancies in diagnoses and treatment options for a bulldog named Marshall, who was declared by a vet to be a healthy animal. The episode identified five areas in which there may be questions about the charges incurred. The Marketplace website describes it this way:

Some vets we visit prescribe vaccines our undercover dog doesn’t need, testing that’s unnecessary, expensive medications and pet food, as well as differing diagnoses for a common condition. And we reveal five ways that your vet bill may be inflated and how to keep your pet healthy and your vet costs down.

You took exception to the presentation of the five areas identified in the documentary, and refuted each of them in turn.

The original version of the broadcast stated that, according to Statistics Canada, pet owners spend 90% more on vet bills than they did ten years ago. You pointed out that the figure was inaccurate and that it actually included the cost of all pet related expenses, not just medical care. You noted that Marketplace had acknowledged the error, but that the “misleading information” was still on the program accessible through the website.

You took issue with the piece’s conclusion that “some veterinarians are vaccinating animals more frequently than necessary.” You explained that it is up to the judgment of individual vets about the appropriate frequency for vaccination:

“Vaccines play a very important role in controlling and preventing infectious disease in dogs and cats and reducing the risk of human exposure to zoonotic disease. Despite what Marketplace seemed to imply, there is no ‘one size fits all’ solution for all pets. Recommendations for vaccines and revaccination intervals must be individualized for each pet. The decision to administer any particular vaccine is based on the risk of contracting the disease and the risk of administering the vaccine, and protocols may vary depending on what disease entities are prevalent in any given area. If you have questions about your pet’s vaccine recommendations, let your veterinarian know and have a discussion about it.”

You also disagreed with the assertion that heartworm testing may be recommended more than it is needed. You explained:

“Heartworm is a parasite which affects hundreds of dogs in Ontario each year, and which would affect thousands more if so many dogs were not receiving preventative medication. How often your veterinarian recommends heartworm testing will depend on the incidence of heartworm in your area, and whether or not your dog has traveled to areas where Heartworm is prevalent. Frequency of testing may also depend on whether your dog received the required dosage of the recommended heartworm preventative the previous year (many pet owners forget to give their dog the preventative medication on the recommended schedule). Talk to your veterinarian about how often your dog requires heartworm testing.”

The next point you took issue with was that “veterinary drugs are more expensive at Ontario veterinary practices than they are in the United States or human pharmacies.” You pointed out that because of the size of the market and different taxation rates, most products and services are cheaper in the United States. You noted the cost of veterinary drugs varies from clinic to clinic or from different pharmacies. You explained that vets have specialized knowledge of animal pharmacology and that “a valid veterinarian-client-patient-relationship must exist before a veterinarian can prescribe or dispense a medication for your pet. This is referred to as the VCPR and it is required by law. The VCPR usually involves face-to-face communication and an exam of your pet, which allows your veterinarian to determine the health status of your pet before making any treatment recommendations or writing a prescription.”

You also disputed the broadcast’s statement that vets recommend premium dog food and special diets more than is necessary. These premium dog foods can be used as a first defense in treating illness, you explained. You added that pet obesity is a growing problem, and an important part of the treatment for managing a pet’s weight is through “eating proper amounts of nutritious food and exercising regularly.”

Overall, you thought the piece suffered because it did not provide enough context or background.

You were not satisfied with Executive Producer Marie Caloz’s response to your complaints, and your Director of Possibilities, Denise Angus, replied to her email, saying you could continue debating each point but that in the final analysis, Barking Mad showed a “biased approach to the presentation of the content.”

She added that “A vet clinic is also like any other for profit business, and must maintain a positive bottom line. Sound harsh? Maybe, but it's a reality. Like any other business, vets have bills to pay; clinic mortgages or rent, electricity, gas, equipment (a single x-ray machine alone can range from 40,000 - 100,000), staff to pay…”

She also said that like human doctors, vets invest long years of training to be able to practice. “Veterinarians have invested a lifetime of schooling, as well as facility and equipment expense out of pocket to care for pets. None of this is funded by any government agencies, like CBC is.’’

MANAGEMENT RESPONSE

The Executive Producer of Marketplace, Marie Caloz, addressed your concerns and the specific points you raised. She explained the mandate of the program is to “focus on the interests of consumers,” and to look at services and organizations from a “consumer’s point of view.” That was the perspective of the episode on veterinary care. She mentioned that the origin of this investigation, as many Marketplace programs are, was from inquiries and suggestions from audience members. In this case, it was audience members concerned over the high cost of pet care. She explained a great deal of research went into the creation of the segment; the program researchers and producers talked to practicing veterinarians and animal health experts. It was on the basis of what they learned from these experts that they focused in on the areas highlighted in the broadcast.

She explained that the clinics visited with a hidden camera were chosen randomly, but that efforts were made to “cover a variety of geographical and socio-economic locations.” The same dog, with up to date shots, was used to assure standardization in the course of the investigation.

She answered each of your five objections in turn. She acknowledged that there was some confusion around the Statistics Canada number of a 90% increase in pet care costs. When the programmers discovered this included services other than veterinary care, the broadcast was amended, as was the material on the website.

As for the frequency of vaccination you were concerned about, she pointed out that Dr. Jim Berry, President of the Canadian Veterinary Medical Association, made the same point that you did – that pet owners need to have detailed conversations about their pets’ needs, and that some individualization might be necessary for some shots. She pointed out though, that for the two basic shots in question here, for rabies and DHPP, professional guidelines now recommend a three year vaccination schedule.

In response to your concern that the need for heartworm testing is contingent on whether the animal got the right dose of the preventative, Ms. Caloz pointed out that it was made clear in each exam that the dog had been on medication to prevent the condition. She pointed out that an expert in the field said on camera that there is no need to test every year if the animal is taking the highly effective preventative medication. She added: “Please note that in our broadcast we repeatedly refer to the cost of heartworm ‘testing’. We in no way suggest that preventative medication is unnecessary.” She pointed out that on this matter too, Dr. Berry was asked for his response to this issue, and he underlined the importance of pet owners talking to their vets, which was included in the broadcast.

She explained that the comparison of price between the United States and Canada was included because this was the experience of the pet owner. Other comparisons were made between pharmacies and clinics across Canada. “The price we report in the program is based on average for the outlets we contacted in Canada.” She acknowledged that it may not always be wise to substitute human for animal drugs, but that the advice the program gives is that pet owners ask for a prescription so they can have choice about where to obtain the medication. “Surely the veterinarian would advise the pet owner if the particular medication is safe to purchase from a human pharmacy before handing over a prescription.”

She explained why the programmers chose to highlight the sale of premium pet foods in the broadcast. A vet diagnosed Marshall, the subject dog, as being 10 kg overweight. She used a methodology to assess his weight provided by the pet food manufacturer, Hill’s Pet Nutrition. She prescribed a premium food made by that manufacturer for 31 weeks. The cost would have been higher than the owner was currently paying for food. The vet subsequently admitted she had made an error in assessing the dog’s weight. The programmers felt that this episode illustrates “how unsuspecting pet owners might be paying more for a product that is not required, and may not in fact have the scientific backing it is advertised as having. In this case, while Hills told us they had conducted scientific studies that back up their claims about proven weight loss, they said we couldn’t see them because they haven’t been published yet.”

In a subsequent correspondence with your office, Ms. Caloz summed up her perspective this way:

“I sincerely appreciate hearing your views. It’s our program’s mission to provide consumers with the information they need to make decisions about product and service purchases. “Barking Mad” was not, as you suggest, a condemnation of veterinarians about the cost of pet medical care, their dedication or their expertise. I can readily understand how demanding a profession this is especially in terms of the time and commitment it requires.

Nevertheless, consumers across Canada have written to us about what they see as the high cost of veterinary care. Our program looked at some of the possible reasons for that perception and, we believe, educated consumers about routine veterinary services so they can make more informed decisions about their pet's care in consultation with a veterinary professional.”

REVIEW

Yours was one of over a dozen complaints this office received about the Marketplace episode “Barking Mad.” Almost all of them were from veterinarians or those affiliated with animal medical care. They expressed hurt and dismay at this broadcast. I have no doubt that veterinarians are caring, compassionate, highly skilled professionals. I understand that they are also running a business that must work on market principles. The reality is that, unlike human medicine, where fee schedules are set by provincial governments, veterinary medicine operates under no such constraints. Its national association, the Canadian Veterinary Medicine Association, (CMVA) has a fact sheet about fees on its website. It explains that fees are partially dependent on a variety of factors: the length of the consultation, the cost of living (rural versus urban practice) and the level of specialty required, among many determinants. It explains prices can appear high because, like human medicine, the practice has become much more technologically driven, and the equipment is expensive. There is a need to provide around the clock care, and there is growing specialization. This is what the Association has to say about fees:

Veterinarians can charge what they deem to be appropriate and reasonable fees for veterinary treatment/services. However, they should be able to justify the costs to their client. Clients can request an estimate of cost before agreeing to proceed with recommended treatment.

As Ms. Caloz explained, Marketplace’s mandate is to look at services and organizations from the perspective of the consumer. In this case, the program chose to examine the processes and costs of veterinary care in Canada. That means by definition they must do so by asking hard questions, and pointing out those areas where a consumer ought to be cautious or questioning. But they must also do so within the parameters of CBC Journalistic Standards and Practices. This means that other perspectives must be brought to bear where appropriate, and those who are subject of criticism are given a right to respond.

The policies in question include fairness and impartiality. Fairness requires even handed treatment of individuals and organizations. Impartiality states:

We provide professional judgment based on facts and expertise. We do not promote any particular point of view on matters of public debate.

The important thing to note here is that there is latitude to draw conclusions based on facts and expertise. The Marketplace team did substantial amounts of research and spoke to acknowledged experts in the field of animal health and medicine. Based on that work, and the results of its hidden camera investigation, it drew some conclusions, summed up by presenter Erica Johnson at the outset: “Wait til we reveal the top five ways you may be paying too much at the vet. You’ll be barking mad.” Note it does not say you are paying too much at the vet. There is a caveat emptor that is used here.

The broadcast goes on to illustrate those areas that might lead to unnecessary charges. The tone is cheeky, and perhaps that is one reason some of the subtlety of the discussion is lost. In fulfilling the requirements of the policy, the programmers also put each concern or treatment decision highlighted to the head of the CMVA, Dr. John Berry. On the matter of the rabies and DHPP he is asked why vets might still be vaccinating despite the 3 year guideline. His answer is similar to the point you made in your complaint:

The data suggests three years, but the individual decision depends on a conversation between the veterinarian and the client… If your veterinarian believes, for whatever reason, that the risks warrant doing a yearly vaccine, as opposed to an every third year vaccine, then that is appropriate.”

Erica Johnson also points out that six out of ten vets consulted recommended revaccination, but she also includes a vet who does not recommend the shots who says “I don’t like to over-vaccinate.”

The pattern is repeated for the other areas you raised in your complaint. For example, not only is an expert in animal parasites consulted to establish a context for the discussion around testing for heartworm, Dr. Berry is again asked to speak to the range of advice given to the pet owner:

ERICA JOHNSON: And all that testing sure is big business. We crunch the most recent numbers for Ontario alone. In 2010, vets did more than 289,000 tests for heartworm. That adds up to almost $14.5 million pet owners shelled out. We tell Dr. Jim Berry, top dog at the Canadian Veterinary Medical Association. (Interview): When pet owners bring their animal in to see a vet, they trust that what they’re getting is the best information for their animal, and for their pocketbook.

DR. JIM BERRY: Clients are more than welcome to ask why, what is the recommendation based on?

ERICA JOHNSON: The point is, owners should be given choices and information before they’re billed for things.

DR. JIM BERRY: And I would argue that most vets offer a lot of choice.

One of the vets who had recommended testing is asked to explain her decision on camera. She replies “It is just to be on the safe side.” The point is that consumers now have a range of perspectives and thoughts to make decisions about their animals’ health care. It is up to them, as Dr. Berry suggests, to ask more questions, or to follow advice they are given without questioning.

The program fulfills another policy requirement. The vets recorded on hidden camera are provided an opportunity to explain their positions, as is laid out in the clandestine recordings policy. When a vet miscalculates the appropriate weight for Marshall, the test dog, she is given the opportunity to explain, and to also reinforce her message that premium dog food is more efficacious for animals.

Another segment of the program reveals that there can be a wide range of diagnoses for a similar condition – in this case dry eye. In the end a specialist minimizes the severity and prescribes drops. The program does not state that the professionals who recommended surgery were necessarily wrong. Various complainants pointed out that there can be a difference in opinion. The point here would be, as was the message of the program, that it is important not to take everything at face value, and to be an informed consumer. Marketplace has conducted this kind of investigation involving other professions where there can be a great deal of discretion and high costs – dentistry for example.

Based on the facts of the investigation undertaken, host Johnson concludes:

All told, we get dinged with a lot of unnecessary charges for Marshall, adding up to $525. Back at the Canadian Veterinary Medical Association, Marshall may be dozing, but our findings sure are a wakeup call. Had we gone along with every unnecessary treatment that was recommended for him, we would have been out hundreds of dollars. That is a lot of money. Is that what people should expect at the vet?

DR. JIM BERRY: You need to have a very active conversation with your veterinarian. We will find lots of ways to work with you to maximize the health of your pet and to minimize cost.

ERICA JOHNSON: Well, if you don’t wanna take it lying down, don’t be barking mad. Ask your vet about three-year vaccines. If your pet's on a drug to prevent heartworm, consider whether he really needs the annual tests. Regular vet checks are important, but be sure to ask questions and shop around.

By raising these issues and pointing out anomalies, the program is not condemning all veterinarians. It is raising questions about some behaviors and practices, and that may be critical, but it is certainly justifiable. Professionals and organizations face extraordinary levels of scrutiny and questioning in this internet age. I note that there are several sites that rate vets, doctors and other professionals. I can understand why you would want to see all the good work done, all the happy patients profiled, but that was not the focus of the piece. Marketplace undertook, on behalf of pet owners, to ask hard questions about veterinary service and to unearth some best practices. They did so within the parameters of CBC journalistic policy. The only exception was an initial error in accuracy, which was corrected and noted as such, as policy demands.

Esther Enkin
CBC Ombudsman