Hypocrisy or ...?

[BigAl]

.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 to.. ..determine 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. T..he 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 ([email protected]). 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...

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[rEliseMe]

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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[quiteaud]

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.

 

[Dustbug10]

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.

 

[rEliseMe]

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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[quiteaud]

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.

 

[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.

 

[rEliseMe]

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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[cmc271]

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?

 

[BigAl]

@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

 

[quiteaud]

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.

 

[Dustbug10]

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.

 

[BigAl]

Thanks Dusty, this pretty much says it all.

Sorry to hear quiteaud.

 

[TheEarDoc]

I can remember the first AAA convention I went to where they threw out iPod nano's into the crowds. I remember AAA in Charlotte being the last year they had give-aways. I didn't attend AAA in San Diego last year or Boston this year, but heard about this fiasco.

I understand AAA's stance on the non-give aways. AAA is trying to make audiology an ethical profession like physicians are. Physicians used to have all kinds of freebies thrown at them by pharm companies and that was seen as a conflict of interest.

I understand the ethical argument. Now I'm a big boy and I know that a company giving me a $30 target gift card or a free meal isn't going to make me buy your product and sell it to my patients, but it's about appearances. It doesn't matter if the gift (no matter how small or large) would sway me to fit a certain company, what matters is the appearance of a conflict of interest. We cannot deny that when the public sees such things they are going to wonder why you fit that product. IS it because it's the best product for me as a patient or is it because this company gave me a kickback?

I've spoken to several presidents of the companies and sales reps as well as several AAA members (including board members), Yes the give aways were awesome, but they do not make or break a convention. In the end the moral and ethical high road is what's important. Remember integrity is doing the right then even when no one is watching.

Starkey, well I fit some Starkey products. I love their custom products and I've been able to put CIC's and ITC's on patients that refused to wear anything else successfully with Starkey products that I could have never done with any other product. They have a niche. I also like their completely wireless products (and Resounds for that matter) and they are extremely easy for even elderly patients to use. The tv adapters are awesome in both companies! Starkey has always been kind of the bad boy in the industry in terms of pushing the envelope for ethics in my opinion. Anyone remember when their party was supposed to have a very famous band at it and suddenly on the night of the party said band could not perform? Felt like a bait and switch a little. The scholarship thing was a direct violation of the terms Starkey agreed to as a vendor at AAA. They broke the rules, end of story. I don't fault the students. I was poor as a grad student (still am thanks to student loans) and an extra $500 is nothing to scoff at!

Wasn't the training in Vegas that Dr. Fabry speaks of provided to providers who sold a certain amount of units? I could be off base, but if I remember correctly I'm not. In the end the vendors do really put up a lot of the cash to run the convention, but this is better for us as a profession. Fabry is a stand up guy, I thought he was awesome when he was president of Phonak. I think Starkey pushed the ethics envelope and got their hand slapped a little. Everyone learned from the experience and it opened a little bit of dialogue on ethics, which isn't a bad thing.

I'll still continue to fit Starkey instruments on patients, as well as Resound, Phonak, Widex, Oticon, and many others because I don't really have a favorite. I tailor the product to the patient. That's what a lot of us do. That's what we are supposed to do! Even though the big six are all in the same patent sharing group, it doesn't mean they are all equal on every technology. Some companies do better with certain products than others. For example:

Starkey - amazing custom products, can put customs on patients even up to flat severe losses with no feedback!

Resound - amazing tinnitus devices in their hearing aids and their wireless adapters that don't require a neck worn streamer device is a God send for my patients
- Best feedback cancellation system I've ever worked with. I've fit patients with RIC's that were in power BTE's without feedback issues!

Widex - one of the best tinnitus devices in the mind series of hearing aids

Phonak - amazing FM systems

Oticon - they make very cosmetically appealing devices!
- The Chili9 super power is one of the best power hearing aids I've ever worked with!

They all have a niche and I use the niche products to make the process of hearing again the easiest it can be for my patients.

Let's all be ethical and if it doesn't pass the smell test, then let's not do it. That's what separates Audiology from hearing aid dealers and used car salesmen.

 

[BabyBleusMommy]

I can definately see both sides of this issue... somehow the same situation always comes to mind when I think about situations like this.

Mind you...this is a very far removed example since I have been married nearly 9 years... but ...

Implying that I can't resist selling a certain manufacturer because they gave me a gift is no different than implying that I went home with every guy who has ever bought me dinner I have the ability to act independent regardless of gifts...

but then again we have all known at least one person that went home with everyone that ever bought them dinner! lol

A very slippery slope for some. I know that I will always choose the best manufacturer for my patients because I don't want to deal with headaches because aids aren't very good. A happy patient makes my life easier...

If anything the part that I am most bothered by with this whole thing is that it only was for students who could afford to go to AAA... those students who couldn't afford it, or those who have children and a hubby that works nights couldn't profit! (not saying I would since I would hate to be on film, lol)

 

[Dustbug10]

It's kind of funny watching the youtube videos that have been posted by Starkey. It's almost incriminating given the 'controversy'.

Aside from hypocrisy and ulterior motives, what do you guys think of donating the scholarship funds? Still an ethical dilemma?

 

[Kitska]

There is an Audiology Online course all about ethics by Barry Freeman who now works at Starkey but was previously a professor at Nova Southeastern and also AAA president among other things. As students, we can view the courses at AudiologyOnline for free! The presentation has some interesting graphs of how various groups (audiologists, consumers, dispeners) view various activities. One main point is that it is all about what might be a patient's perception of an activity.
http://www.audiologyonline.com/ceus/recordedcoursedetails.asp?class_id=19325

 

[BigAl]

One main point is that it is all about what might be a patient's perception of an activity.
http://www.audiologyonline.com/ceus/recordedcoursedetails.asp?class_id=19325

I'm in total agreement with that, but where do we draw the line? A patient can perceive us making a commission off hearing aids sales as unethical, then what?

 

[Kitska]

I'm in total agreement with that, but where do we draw the line? A patient can perceive us making a commission off hearing aids sales as unethical, then what?

I actually have a problem with commissions myself. I don't think I would want to work selling on commission. I personally feel it is a conflict of interest.

 

[Dustbug10]

I'm in total agreement with that, but where do we draw the line? A patient can perceive us making a commission off hearing aids sales as unethical, then what?

The majority don't seem to according to Freeman's article.

I actually have a problem with commissions myself. I don't think I would want to work selling on commission. I personally feel it is a conflict of interest.

What's your reasoning? Just playing devil's advocate for discussion. I agree that it can easily lead to situations involving unethical practice. But simply stating that commission earning in general is unethical seems narrow. Even hospitals can show bias towards manufacturers based on certain factors, only it's not the audiologist who benefits. I don't believe you fit this category at all, but some of the white knights out there simplify this issue to the point where by their logic, we should all just accept minimum wage for the services we provide.

 

[Kitska]

What's your reasoning? Just playing devil's advocate for discussion. I agree that it can easily lead to situations involving unethical practice. But simply stating that commission earning in general is unethical seems narrow. Even hospitals can show bias towards manufacturers based on certain factors, only it's not the audiologist who benefits. I don't believe you fit this category at all, but some of the white knights out there simplify this issue to the point where by their logic, we should all just accept minimum wage for the services we provide.

It really doesn't bother me if other people are comfortable working on a commission basis. I just don't want to work on a commission basis myself. Commissions = sales-focus in my mind, rather than a health care focus. It's more of a personal thing I would rather be rewarded for my work in other ways, and have my compensation be based on how I interact with patients, if they are pleased and come back and recommend the practice to others, not based on how many hearing aids I sell. I will say, though, that it was a topic that came up in our professional practice as well as ethics classes and the teachers of those classes (one in private practice, one working for the government) were a little down on commissions too. Maybe I have been brainwashed! I don't know how common commission-based sales are. According to the 2010 ASHA salary survey, less than 20% of those surveyed received commissions.

Of course one could argue that otologists are compensated based on how many ear surgeries they do, and how is that different from commissions? I have been in a situation where I am convinced a orthopedic surgeon wanted to operate on my son's shoulder just for the sake of doing the procedure and cashing in (it healed fine with some physical therapy, and not having the surgery meant he did not miss a season of his favorite sport) and it made me pretty mad at the surgeon!

But I would personally put up with commissions over monthly sales targets. How would a patient feel knowing that they were being convinced to get a new hearing aid even though they really didn't need one yet just because it was the end of the month? (For the record, I also like the transparency of unbundling.) I think I must be a socialist...

What do other people think? Please convince me that commissions are OK (even though I have partly convinced myself.)

 

[Kitska]

P.S. Here is what AAA has to say on the subject:
http://www.audiology.org/about/membership/ethics/Pages/ea2007a.aspx