Published 5 January 2009, doi:10.1136/bmj.a3179
Cite this as: BMJ 2009;338:a3179

News

Stepping into the therapeutics void

¹ London

As the number of therapeutics departments in medical schools falls, Rebecca Coombes hears how the drug industry is stepping into the breach

Drug company staff are providing direct teaching to UK undergraduate medical students, a model that the industry hopes can be developed to forge valuable links with trainee doctors.

The move comes as many medical schools are moving investment away from clinical pharmacology to concentrate on research.

Pfizer has a contract to deliver a module to undergraduates at Brighton and Sussex Medical School, a new school that does not have a clinical pharmacology department. Pfizer does not charge for its services, and students travel to the company’s headquarters in Walton Oaks, Surrey, for a series of seminars with staff.

The Association of the British Pharmaceutical Industry (ABPI) is also delivering talks to undergraduates at several medical schools. Richard Tiner, its medical director, said he was in talks with senior lecturers, including at the University of Leeds School of Medicine, to provide general talks on the industry, drug development, and adverse drug reactions. He believes that UK medical academics were becoming more receptive to offers of help from the industry.

"Three to four years ago we weren’t doing anything like this. Last month we had two such talks in a week," he said. "Clinical pharmacology teaching is diminishing in medical schools—many don’t have clinical pharmacologists on the staff. There is a realisation that industry has expertise in certain areas that may not be available in all of the medical schools in the UK."

Pfizer says that its experience with Brighton and Sussex has been successful. Joanna Hahn, a medical manager at the company, who runs the course, said it was a student selected component that runs half a day a week over two months. The module is ungraded, although students need to pass it to get their overall degree. The course covers topics from drug discovery through to marketing.

Ms Hahn said, "It’s an overview of how it all happens. In the early stages we invite doctors from the research laboratories to talk about drug development and to focus on risk assessment and safety. During the second half of the module we look at regulation, the Medicines and Healthcare Products Regulatory Agency, and post-marketing surveillance. We also look at marketing in the true sense, not just advertising."

The company’s external affairs staff also address students on its "stakeholder strategy," which includes relationships with patients’ groups.

Ms Hahn said the sessions with students were very interactive and that she was sensitive to the need to be objective.

"It is not promotional in any way, shape, or form," she said. "When students first started coming here I made sure drinks were available and sometimes lunch. But I stopped that because it reinforced the perception of free lunches. The whole essence of the programme is not about promotion or manipulation but to have an open discussion, to say, ‘Here is what is happening in our world.’

"We are not trying to hide anything. If anything comes up in the news we discuss it [and] find the right people to speak about it."

Brighton and Sussex offered Pfizer £500 (510; $720) to deliver the course, but the company declined the fee.

Ms Hahn said, "The main thing we get out of this is the opportunity to interact with the junior doctors of tomorrow. We get to see how we are perceived in the outside world and to give some information. Students are a little bit sceptical at first. But we have good quality conversations. Initially we had students coming through saying, ‘You aren’t doing enough in developing countries.’ The latest lot of students have said, ‘We want to make our own minds up.’"

Martin Kendall, senior medical adviser to the British National Formulary and emeritus professor, clinical pharmacology, at the University of Birmingham, said it was "a major indictment" that many medical schools no longer had a proper department of therapeutics. He was not surprised to see companies such as Pfizer moving in to fill the gap.

"In terms of managing patients," he said, "therapeutics is an important subject. Doctors start prescribing from day one. It is worth remembering that 6.5% of patients admitted to hospital are suffering from adverse reactions to drugs. It is not just the newer medical schools, but the older ones too, who have no identified department of therapeutics. This is actually serious, a major indictment.

"I think this is related to the research assessment exercise. Medical schools are competing in terms of research output and are judged by the amount of money they raise for research and whether they are published in high quality journals. If you were a dean and want to be successful, what you need to do is build up research and reduce subjects such as psychiatry, elderly care, and therapeutics.

"If it means that Pfizer develops a module to teach medical students, that’s not necessarily a bad thing. No doubt people in the drug industry will have expertise and the potential to teach students about aspects of drug development. For example, how do you create a new antihistamine?"

However, Professor Kendall was concerned about the difficulties of maintaining objectivity in teaching. If a company was giving a lecture on the management of angina, he said, there would be a clear risk of giving preference to their own drugs.

"I’d say it is OK as long as it is properly monitored," he said. "If a module is put on by Pfizer, for example, it does need to be monitored by an external examiner or by, for example, the clinical committee of the British Pharmacological Society."

"If the industry does a good job then the medical student will look on that company as a friend. This might have quite an impact on the doctor when that company’s representative comes knocking at the door. It’s not active marketing but building up a reputation as coherent scientists."

Richard Tiner of the APBI said that any teaching offered by companies was governed by the industry’s own code of practice.

"This teaching is coming from medics working in the pharmaceutical industry. Anything we do is covered by the ABPI code of practice. We are not able to promote specific medicines. These are general talks rather than about specific medicines. Usually there is a member of [faculty] staff present."

Cite this as: BMJ 2009;338:a3179

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