Hypocrisy or ...?

Not sure how many of you received this email from the national SAA, below it is in its entirety.
I find this email a bit hypocritical and an overreaction to a non issue. Let me first start by saying that what the AAA is doing with these conventions can be considered unethical. Have you seen all who sponsor this event? Yep, all of them are manufacturers such as Starkey, Oticon, Phonak and many more. As some of you may know and most may not, that the manufacturers are buying out small practices and making them subsidiaries, guess who that hurts at the end? Has AAA been outspoken about this? Nothing that I have seen as of late, but if I am mistaking feel free to point me into the right direction. As an observer on the sidelines, it would seem that AAA would not broach this issue as they may lose sponsorship for AudiologyNOW!, at least that’s what it seems like from this side of the field. After all isn’t that why we can’t get pens anymore, it may seem that we are in the bag for that manufacturer if we do.

Now let’s look at the scholarship that was given out. Last I checked many scholarships come from private industry, the onus of being ethical falls upon you on how you spend that scholarship money. If you decide to go and by a bag or shoes, instead of spend it on your education, well guess what, you’re being unethical according to the guidelines you choose to abide by.

It seems to me that AAA may be a bit bitter that Starkey is not coming back next year or maybe even ever. To suggest that more ethical regulations need to be set into place will lead to the suffocation of the profession. Before AAA and SAA start pointing their fingers and begin stuffing more regulations down our throat they need to look at themselves in the mirror.

Let me make something clear, I was a supporter of AAA and the SAA, so much that I started a local SAA chapter at my school. But, recently the promotion of the field or even the protection of the profession for the future doesn’t seem to be the main focus of AAA. They are more concerned with fighting ASHA and making sure no one hands out pens or cups at the convention.

Last thing, fighting for the comprehensive hearing healthcare profession (ASHA) is a bit more important than fighting for direct access (AAA), but that’s for another topic.

EMAIL:
Dear SAA Member:
Ethics. How do ethical decisions relate to best practice? Audiology programs across the country discuss ethics in clinical practice and some programs even have a class specifically devoted to this topic. As audiology students, much of our coursework is factual with the content being, ‘black and white’. However, students are faced with offers from the industry in which the best decision is not always clear.
Unfortunately, information found in textbooks and discussions with professors and preceptors will not be able to teach us how to handle every ethical dilemma we face throughout our careers. As students, the national membership organization can help provide you direction and clear the fog that hangs over the professional relationship with manufacturers. Through the professional code of ethics and other contemporary guidelines and policies, appropriate behavior for best practice can be further defined.
During AudiologyNOW! 2012 in Boston, you may have received notification about the following giveaway sponsored by Starkey Hearing Technologies:
“Stop by the Starkey booth to give a video testimonial about why you chose Audiology. Starkey is giving a $500.00 scholarship to the first 400 AuD students who show up to do this on Saturday. We have been told that the number of scholarships may be extended beyond 400, AND there may be opportunities to do this on FRIDAY. Check for details at the Starkey booth in the exhibit hall. I hope you all are enjoying the convention!”
Students who participated in the offer signed a consent form that allowed their video to be placed on YouTube and were informed they would receive a check, in their name, to be mailed to an address the student provided. We know that the email came with the AudiologyNOW! logo attached so it appeared that the Academy had approved and/or vetted the offer. The Academy, specifically the Board of Directors, the Director of Industry Services nor any of the program/convention planners, were not apprised of the offer until after it had been disseminated to students/faculty.
Upon review by the Ethical Practices Committee (EPC) and the Academy’s legal counsel, the following information/advice is provided to you:
1. You should check with your academic training program and your university todetermine if there are any guidelines on accepting gifts directly from private industry prior to accepting any offers from any company outright.
2. The current Academy Code of Ethics and Academy Guideline for Relationships with Industry clearly prohibit the acceptance of such a gift by a professional audiologist who is a member of the Academy.
3. Students, as members of the Academy, are required to abide by the Code of Ethics and ethical guidelines as published. However, they are typically not in a position of authority to recommend purchase and/or prescribe treatment during their training as they do not hold a degree from an accredited university and state licensure to practice autonomously. The current Code of Ethics/guidelines do not specifically address what may or may not be advisable for students to accept as members of the Academy based on the student’s limited ability to make independent purchasing/prescribing decisions. However, the preamble to the Academy’s Code of Ethics is excerpted here and clearly states that students are Academy members and therefore are obligated to abide by the Academy Code of Ethics:
“The Code of Ethics of the American Academy of Audiology specifies professional standards that allow for the proper discharge of audiologists’ responsibilities to those served, and that protect the integrity of the profession. The Code of Ethics consists of two parts. The first part, the Statement of Principles and Rules, presents precepts that members (all categories of members, including Student Members) of the Academy agree to uphold. The second part, the Procedures, provides the process that enables enforcement of the Principles and Rules.”
4. The American Academy of Audiology and the Student Academy of Audiology (SAA) are currently reviewing whether specific ethical prohibitions should be developed for students because of situations such as that outlined above.
5. You should review the current ethical guidelines in this area (see links above) and make a personal decision (along with your faculty advisors) as to whether the acceptance of such a gift is appropriate in light of your future professional endeavors.
If you have any questions, please feel free to contact us directly (saa@audiology.org). This e-letter has been sent to all SAA members and to Academy members in academia so that students and faculty are apprised of the ruling of the EPC and legal counsel for the Academy.
Sincerely,
The Student Academy of Audiology, Board of Directors
Kari Morgenstein, President
Stuart Tomlin, Vice President
Ryan Bullock, Past President
Mariah Cheyney, Secretary
Rud Nast, Treasurer
Stephanie O’Bryan, Chapter Relations Committee Chair
Nicole Corbin, Humanitarian Committee Chair
Andrea Fowler, SAA Programs Subcommittee Chair
Sara Neumann, Education Committee Chair
Brianne Wright, Ph.D Committee Chair
Cory Workman, Media Committee Chair

I'm also struggling with this. On one hand, I understand AAA's argument. On the other, I need the money and the money is in exchange for a video testimonial about audiology. Property changed hands... Doesn't that make it a service fee, not a gift?

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I'm having a hard time expressing my thoughts given that we're not exactly anonymous on this forum, not to mention the fact that I consider a few of those individuals who signed the email to be my friends. I can say that I am surprised at some of the names on the list, particularly if they don't feel 'conflicted' in supporting this message. I'll leave it at that.

The points made by the academy are acceptable... on principle. However, it has always irked me when someone with an agenda (no matter how small or secondary) calls another out under the guise of principle. This is exactly what turns people off from becoming active in either of the accrediting bodies. Publicly decrying questionable ethics is a good thing, but one would have to be pretty daft to believe this message is altruistic in nature. I know that someone will likely post a carefully worded rebuttal on this thread and claim the ethical high ground. Admittedly, I've been that guy, naive to the politics at hand. I suppose that is a good way to be.

It's just demoralizing to see the field split into a hundred different factions, all chomping on the bit to use any advantage available to make themselves look better or higher. It makes honest discussion and debate of such ethical dilemmas impossible. Well said as always, Al.

Dustbug, why do you think SAA's message is not altruistic? If your friends who signed the email are of a different opinion, that's one thing... I mean, maybe they were embarrassed to say something while the others were drawing up the email or something. But that doesn't mean they somehow have ulterior motives in writing the email. What would be an example of a possible ulterior motive on the part of SAA?

rEliseMe, you're right that ethics is a gray area, but you shouldn't have to work sooo hard to make something seem right. A 40 second video is obviously not $500 worth of work. There is something else going on.

BigAl, yes, SAA is obviously associated with AAA, but it has a certain amount of independence, so I really wouldn't call this "hypocrisy." The SAA board is welcome to speak out against ethical problems, even if they are occurring at AAA events.

My program would never allow a student to accept this type of scholarship due to the inherent conflict of interest, so it's something I've always been pretty tuned in to. However, at AudiologyNow! this year and last, I have met students from other programs and have realized they did not have a similar point of view and didn't even seem aware of the opinion that such a scholarship may be problematic. I appreciate that SAA is bringing this issue to the forefront.

This is not a "non-issue." The concern is not that people will spend the money on shoes and handbags, but rather that they will favor Starkey in the future, consciously or not. Starkey didn't give those scholarships out of the kindness of their hearts; they gave them to encourage students to work with Starkey in their careers.

rEliseMe, I think you're twisting the situation to make it look how you want it to look. Starkey not only gave out scholarships in the hopes that the recipients would work with them in the future, but they got those students on camera essentially advertising for Starkey. Yes, the students are talking about audiology in general, but there is also a video of them on youtube with their names and their universities' names, together with the name Starkey, essentially creating an endorsement from that student and even from that university.

You do make a convincing argument.

By the way, I wasn't twisting anything. I started my post with the statement that I can understand AAA's stance. It's just not as black and white as you're presenting it. Ethics is an inherently gray-area field.

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if the money was coming from Starkey Foundation, then the whole thing would be moot because it's technically a separate entity not associated with Starkey. Starkey donates to the foundation, then the foundation (which has a separate board of directors) decides what to do with the money.

anyway, that's considered ok, and in my opinion it basically comes down to money laundering and is hardly different than accepting money directly from Starkey.

obviously we would all say that accepting this scholarship won't influence our clinical decision-making, but at the same time the laws are there to protect consumers and we have to respect that.

if there's a loophole in the AAA laws that makes it not a violation of their code of ethics, then i'm taking it because i could use $500.

Originally Posted by cidanu

if the money was coming from Starkey Foundation, then the whole thing would be moot because it's technically a separate entity not associated with Starkey. Starkey donates to the foundation, then the foundation (which has a separate board of directors) decides what to do with the money.

anyway, that's considered ok, and in my opinion it basically comes down to money laundering and is hardly different than accepting money directly from Starkey.

obviously we would all say that accepting this scholarship won't influence our clinical decision-making, but at the same time the laws are there to protect consumers and we have to respect that.

if there's a loophole in the AAA laws that makes it not a violation of their code of ethics, then i'm taking it because i could use $500.

From how I interpreted the email, they can't technically prohibit you from taking the money as you are still a student.

I've been talking with several of my classmates who were also at AAA, it's been an interesting topic. In one sense, I can argue about how is it really that different than going and see Third Eye Blind at a private concert (probable $50-100 /ticket to see a concert) and consuming $50-100 dollars of food and alcohol depending on how much you eat and drink etc. I don't think any of us (generalizing!) felt any qualms about doing that? This however is dealing with Straight Cash Homie! and has definitely caused me some discomfort. Like others have mentioned, I like to think that this will have no impact on me in clinic right now, especially because I rarely recommend any Starkey products. They are just not one of the manufacturers we use often.

One of my classmates has told me she needs the money to help pay her tuition during her 4th year and will be keeping it. I can not fault her for that in the slightest. Similarly another said she is returning it. I think that since it has made me feel uneasy since I did it, I am leaning towards going with my gut and returning it.

Just my $.02

As an aside, BigAl can you elaborate on this whole Starkey not coming back to AAA thing?

@quiteaud you are really reaching out there to grasp on to an unethical branch. to suggest that $500 dollars is going to sway the opinion of a 1st yr, a 2nd yr or even a 3rd yr student to be more acceptable of starkey when they graduate is really pushing it. i would consider starkey based on what they are good at and whats good for my pt, and that is custom HA, not because they gave me a $500 scholarship 3 yrs ago.
with your statements, we can assume that you don't go to any of the parties at the convention, nor do you attend any of the site visits or camps that various manufacturers offer?

@cmc271 they said they will no longer be participating at audiolognow!. from what i've heard they are having some sort of their own tech expo thingy. maybe if they didn't spend so much money on glitzy booths and over the top parties, than their products might be cheaper. but what do i know i'm only an aud student

we can assume that you don't go to any of the parties at the convention, nor do you attend any of the site visits or camps that various manufacturers offer?

Correct.

From Dave Kirkwood's column on HearingHealthMatters.com:

In an interview on March 29, David Fabry, PhD, Starkey’s managing director for the U.S., told Hearing News Watch that the company’s decision was based entirely on business considerations. Fabry, a former AAA president, said that as the industry has changed, manufacturers have developed new ways to interact with existing and potential customers. It is no longer clear, he said, that the benefit to the company of exhibiting at AAA is worth the high cost. Starkey has long constructed some of the largest and most elaborate exhibits at Audiology Solutions, as the academy calls its exposition.


The decision means that Starkey will give up the opportunity to showcase its offerings at what is by far the largest gathering in the world of hearing care providers. This year’s meeting in Boston is expected to draw close to 8000 attendees in all, the most ever.


However, Fabry noted, Starkey’s Hearing Innovations Expo, which debuted this January in Las Vegas, drew a large turnout of hearing professionals. The company reported that about 3000 Starkey customers from 27 countries attended the event, which also had featured speakers including former President Bill Clinton and Richard Branson, founder of Virgin Industries. Starkey plans to hold another Hearing Innovations Expo in January 2014.


Fabry also pointed out that Starkey, like most of the other major hearing aid companies, already has a large number of affiliated practices. The increasing involvement of manufacturers in the retailing of hearing aids means that fewer of the dispensing professionals who attend AAA and other meetings are not already committed to a particular manufacturer.


Fabry said that Starkey has made no decision to stop exhibiting at the smaller conventions, such as those of the International Hearing Society and the Academy of Doctors of Audiology. He also emphasized that the company would continue to be supportive of AAA and would participate in its annual convention, but not as an exhibitor.

It’s too soon to know if any other major companies will follow Starkey’s lead. However, it’s an open secret that there’s been growing disenchantment within the hearing industry over the terms and conditions of exhibiting at AAA.


On the one hand, AudiologyNOW! delivers far more people to their booths than does any other meeting. That’s why the big manufacturers compete so hard to build the most lavish and enticing displays. On the other hand, companies complain that AAA charges exhibitors too much, especially since so many of those who pack the exhibit hall are students who may be years away from becoming customers.


There has also been grumbling by some companies over the ban on handouts at booths. What the academy sees as a matter of professional ethics is viewed by some companies as an unnecessary limitation on what they can do to draw people into their exhibits to learn about their latest technology.

Originally Posted by quiteaud

rEliseMe, you're right that ethics is a gray area, but you shouldn't have to work sooo hard to make something seem right. A 40 second video is obviously not $500 worth of work. There is something else going on.

That's a lot of "o"s. I didn't work that hard, I just thought about it. Isn't that the point, though? Encouraging thought and open discussion?

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