Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Transparency works both ways
- Adam Jacobs (22 February 2008)
-
Internet is Best
- Bernard C Boyd (23 February 2008)
-
And Who's Doing the Studies?
- Joseph More (23 February 2008)
-
Another perspective
- Aitzaz Bin Sultan Rai, Saima Amin Mughal, Mohammad Jawwad Arshad, Ahmed Ayaz Sabri (23 February 2008)
-
Transparency works both ways
- Alan K. Cassels (24 February 2008)
-
Pharmaceutical Industry’s visible influence on doctor’s education: No free lunch
- Imran Mushtaq, Hind Al-Khairullah Associate Specialist-Child and Adolescent Psychiatrist (24 February 2008)
-
Who Pays for the Lunch?
- Aitzaz Bin Sultan Rai, Saima Amin Mughal (24 February 2008)
-
Sponsored medical tourism
- Peter C Arnold (24 February 2008)
-
A need to be vigilant
- Allison CY Tso (25 February 2008)
-
Doctors are not victims - and conflicts are everywhere
- Hari Singh (26 February 2008)
-
Doctors and drug industry : Cruising along , in a lifetime illicit relationship
- venkatesan sangareddi (26 February 2008)
-
It is our responsibility
- Dr. Rajesh M. Buddhadev, BHAIRAVI R BUDDHADEV , DIRECTOR , MY SKIN CITY (26 February 2008)
-
Does a doctor go hungry if no "free lunch" is available?
- Eugene Pozniak (26 February 2008)
-
Managing the Risk of Influence: Train in partnership working
- Peter H L Aitken (27 February 2008)
-
Training budget cut but CPD points required, how to balanace the books?
- Sudip Sikdar (28 February 2008)
-
free lunches
- dr vikram vinayek (28 February 2008)
-
Useless trials and disclosures to patients
- Anthony Papagiannis (28 February 2008)
-
Is it immoral for an academician to work with the pharmaceutical industry?
- Hari Prasad (1 March 2008)
-
Sponsorship of doctors’ education? No thanks!
- Luisella Grandori (1 March 2008)
-
An insidious disease
- Deborah H Yates, Paul S Thomas (1 March 2008)
-
In the USA, Certified CME is different
- Marty Cearnal, BradBednarz, Mark Schaeffer (10 March 2008)
-
Visible influence: the simple truth behind industry "education"
- Anthony N Fleg (12 March 2008)
-
The "(Un) Holy Nexus- Who to blame?
- Manthan D. Janodia, D.Sreedhar, Virendra S.Ligade, N.Udupa (13 March 2008)
|
|
|||
|
Adam Jacobs, Director Dianthus Medical Limited, London SW19 2RL
Send response to journal:
|
I completely agree with Moynihan that it is not right for a sponsor's influence on educational events to be anything other than perfectly transparent. If a commercial sponsor has been active in choosing speakers or topics for a medical education event, it is absolutely right that the audience should be made aware of it. However, there is a certain irony in this article placing such emphasis on transparency when Moynihan fails to declare his own competing interests. As the author of the book "Selling Sickness" (all about how Evil Big Pharma is using underhand tactics to sell more drugs and boost their profits at the expense of the rest of us), does he not believe he has anything to gain from stirring up distrust of the pharmaceutical industry? Competing interests: My company provides consultancy services to pharmaceutical companies |
|||
|
|
|||
|
Bernard C Boyd, Family Physician, General Practitioner Arima, Trinidad
Send response to journal:
|
It is years now since I attended a local medical meeting "sponsored jointly" by a branch of the Medical Association and ....a BIG PHARMA Co. My preference is to get information from independent sources on the Internet, notably BMJ, Free Med Journals, Medline. I recognise and accept the "launching of a new product", as a shameless commercial bash, and my sole aim then is to meet with some colleagues socially. One presentation was so obscenely and expensively theatrical (like an indoor Rock Concert, and just as loud) that a doctor whispered to me his estimated cost of the product (a three number figure , and he was right!). For my part, I get immense pleasure and satisfaction from printing useful information for my patients, while at the same time adding to and upgrading my own medical skills. Viva le Internet! B C Boyd Competing interests: None declared |
|||
|
|
|||
|
Joseph More, Retired physician 52 Winthrop St. Waltham, MA
Send response to journal:
|
When you are treated to a lavish dinner, you are at least aware of the attempt at seduction. But how can you compensate for the fact that when you do a literature search, most studies are tainted by industry sponsorship? Competing interests: None declared |
|||
|
|
|||
|
Aitzaz Bin Sultan Rai, house officer oncology department , allied hospital Faisalabad, Saima Amin Mughal, Mohammad Jawwad Arshad, Ahmed Ayaz Sabri
Send response to journal:
|
I comletely agree with the authors view that there should be transparency in these educational activities and the these activities should be free from the "Negative" influence of pharmaceutical companies. But we must not forget that these pharmaceutical companies have huge amount of money at stake so they follow the three C's "Convince If possible, Confuse If necessary, Corrupt if nothing else works". I would go one step ahead and suggest that there should be legislation which will restrict the trials for the safety and development of new drugs to be conducted only at renowned academic institutes and not at the laboratories of pharmaceutical companies. In this way we can move towards the "UNBIASED" Research. Competing interests: None declared |
|||
|
|
|||
|
Alan K. Cassels, Drug Policy Researcher University of Victoria
Send response to journal:
|
I agree with Adam Jacobs that transparency works both ways, but it is hard for me to imagine how those who state simple facts about the pharmaceutical industry's involvement in the underwriting of the education of our physicians can possibly be profiting from doing so. What I would really like to know is how exactly a person can make any money by describing factual examples of conflicted relations between drug companies and the prescribing of their products, as that would surely be a growth industry and not the hard-scrabble and astonishingly low paying task it seems to be. Anyone who says the pharmaceutical industry is employing "underhand tactics" in the words of Mr. Adams, risks insulting a whole other industry of medical educators and public relations professionals who, while working under guidelines which permit their behavior, provide valuable services for whoever pays for them. Competing interests: I am co-author with Ray Moynihan, of Selling Sickness. |
|||
|
|
|||
|
Imran Mushtaq, Associate Specialist-Child and Adolescent Psychiatrist Milton Keynes Specialist-CAHMS, Hind Al-Khairullah Associate Specialist-Child and Adolescent Psychiatrist
Send response to journal:
|
No one can disagree with Moynihan’s article on Drug Company’s invisible (to us pretty visible) influence on our education and us (1). Most doctors will claim that industry’s promotion can not influence their prescribing habits (2), although it is controversial. A recent editorial by Timimi (3) in Advances in Psychiatric Treatment, explores relationship of pharmaceutical industry with child psychiatry and is worth a read. I wonder if most doctors (probably most affected are juniors) are relying on drug companies educational meetings, seminars and conferences for their CPD needs, since reduction in study leave budgets by government (deaneries). In the current circumstances, our responsibilities increase on individual and organisational levels to make sure these educational events are free of industry’s influence. We require self regulation, determination and greater transparency to decide which educational meeting is ‘right’ for our ‘pure’ educational needs. Refrences: 1 Moynihan R.Doctors’ education: the invisible influence of drug company sponsorship. BMJ 2008; 336:416-417 2 Sagarin BJ, et al. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. Journal of personal and Social Psychology, 83, 526-541 3 Timimi S. Child psychiatry and its relationship with the pharmaceutical industry: theoretical and practical issues. Advances in Psychiatric Treatment 2008;14: 3-9 Competing interests: IM and HA both have attended educational meetings, seminars and conferences organised and expenses paid by pharmaceutical companies |
|||
|
|
|||
|
Aitzaz Bin Sultan Rai, House Officer Oncology Department, Allied Hospital Faisalabad, Saima Amin Mughal
Send response to journal:
|
I would also like all to read all another article by moynihan (1). We are forgetting a very important point here and that who suffers the most by all these sponsored activities? the answer is simple "the patient" and he is paying the price of all this whether "right" or "wrong". So while attending these dinners or lunches we must remember that who is paying for them and who is at stake.also kindly read this article (2) 1)Moynihan R. Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement. BMJ 2003; 326: 1189- 92. 2) http://jpma.org.pk/ViewArticle/ViewArticle.aspx?ArticleID=1250 Competing interests: None declared |
|||
|
|
|||
|
Peter C Arnold, Retired GP Edgecliff NSW 2027
Send response to journal:
|
Ray Moynihan’s piece prompts me to narrate a recent experience, which I have described in detail at crikey.com. Organising an international medical conference in Sydney, we righteously spurned sponsorship from ‘Big Pharma’. Caesar’s wife had nothing on us. We solicited support elsewhere and ran a successful conference. But, when the final figures were reckoned, we made a sobering discovery. Our success was due in large measure to Big Pharma and Big Surgical Instrument Maker. They had paid the registration fees of large contingents from two Asian countries. Our enthusiasm at seeing those delegates at the registration desk on day 1 was totally negated when, having taken photographs in front of the conference banners, they vanished - to tour the city and, for all we know, the neighbouring countryside or the rest of Australia. How common is this behaviour? What do these companies expect, and receive, in exchange? Is this sponsored tourism acceptable in their home countries? Are the same sorts of offerings made to Australian doctors vis- a-vis trips overseas? Competing interests: None declared |
|||
|
|
|||
|
Allison CY Tso, Specialist Haematology Registrar Hammersmith Hospital, London
Send response to journal:
|
Thank you for the thought-provoking article. The pharmaceutical industry, no doubt, plays an active role in doctors' education, in one way or another. It is not an uncommon observation that junior doctors's attendance rate for educational seminars or grand rounds organised by the hospital increases "significantly" if lunch is sponsored (almost always by the pharmaceutical industry). Although one would argue that it may not be ethically correct, the benefit of educating our doctors may justify our hospitals' involvement with the drug industry. In many circumstances, sponsorship by pharmaceuticals may be the only opportunity junior doctors get to attend important national / international conferences crucial to their continual professional development. I believe every doctor should be professional and vigilant when engaging with the pharmaceutical industry. Whilst taking care not to step over the line of what is generally regarded as inappropriate, doctors should not be made to feel guilty in accepting free sandwiches whilst attending educational meetings. Competing interests: None declared |
|||
|
|
|||
|
Hari Singh, GP Clare Road Surgery, CF5
Send response to journal:
|
Yet another tedious BMJ article on the "evils" of the pharmaceutical industry. Perhaps the BMJ should start to focus on wider aspects of conflict of interest - pharmaceutical advisors peddling the verdicts of NICE, itself bowing to a government remit to contain cost, or to academic departments only publishing postive data from their groups in order to bolster RAE ratings and secure future grants. Conflicts of interest abound in modern medicine and laying all the problems at the door of the pharmaceutical industry seems to be missing the point - or perhaps the BMJ go out of their way to "Industry Bash" in order to make themselves feel less guilty about accepting Industry advertising money. In any case, highly qualified medical professionals should not see themselves as happless victims of a marketing machine, they should simply get smart and trained in how to effectively manage the interface with commercial partners - I recently found some useful training on www.arborvitae.org.uk - but it is a scandal that nowhere in formal postgraduate education is there decent training on how doctors should relate to commerical organisations - which we are increasingly having to do. Competing interests: None declared |
|||
|
|
|||
|
venkatesan sangareddi, Assistant professor of cardiology Madras medical college Chennai
Send response to journal:
|
I read with interest the article by Moynihan While there can be no two opinions about the adverse nature of the prevailing relationship between the doctors and drug/device industry .The only thing I would emphasize here is, it is not an invisible influence as suggested by the author .It is an explicit fact and is going on merrily for the past many decades . And in this part of the world one can see the worst dimension of it . Paradoxically many doctors would justify it . And the real danger is that, even the ethical minded doctors are obliged to have illicit relationship with these companies fearing isolation by the profession ! Few polite articles like that of Moynihan and Blumenthal are bound to have some effect on the profession. Let us at least believe the issue is real and need to be checked, as it is impossible to eradicate . It is wrong to blame the drug companies alone. I wonder , what could be the purpose behind disclosure of conflicts before publication of any sponsored study in major journals . Do they ( Leading medical journals) ask us to “Read with caution or Read and forget" ? Or Do they ask us Implement the study results on patients at our own peril ? All studies with serious conflicts should be rejected straight away ! Venkatesan sangareddi, Assistant professor of cardiology, Madras medical college Chennai , India Competing interests: None declared |
|||
|
|
|||
|
Dr. Rajesh M. Buddhadev, CEO and Director NISARG SKIN LASERS & MY SKIN CITY SURAT-GUJARAT-INDIA 395001, BHAIRAVI R BUDDHADEV , DIRECTOR , MY SKIN CITY
Send response to journal:
|
Thank you for the thought-provoking article. It can always be seen at different angles. It is a multidimensional thing. Some positive aspects and some negative also. But we should be vigilant about its hidden context. Sometimes Educational Forums are not educational but only promotional forums that should not be encouraged by us. To be vigilant is our duty and concern, to be ethical is that of pharmaceutical industry. The pharmaceutical industry, no doubt, plays an active role in doctors' education, in one way or another. It is not an uncommon observation that junior doctors' attendance rate for educational seminars or grand rounds organized by the hospital increases "significantly" if lunch is sponsored Although one would argue that it may not be ethically correct, the benefit of educating our doctors may justify our hospitals' involvement with the drug industry. In many circumstances, sponsorship by pharmaceuticals may be the only opportunity junior doctors get to attend important national / international conferences crucial to their continual professional development. I believe every doctor should be professional and vigilant when engaging with the pharmaceutical industry. Whilst taking care not to step over the line of what is generally regarded as inappropriate, doctors should not be made to feel guilty in accepting free sandwiches whilst attending educational meetings. Hope things goes in good direction in future. Dr Rajesh M. Buddhadev
MD,
CEO,
Director
Competing interests: None declared |
|||
|
|
|||
|
Eugene Pozniak, Managing Director Siyemi Learning, SK10 1JN
Send response to journal:
|
A very interesting article, but yet another devoid of any exploration of possible workable solutions. Over the past decade the we have moved to greater transparency, from all parties involved (including publishers, medical institutes and the pharmaceutical industry), across most educational vehicles; but with this article we are left dissecting leaked emails about how experts have been chosen (and not even whether they were indeed inept or biased). It would be good to steer the debate away from angels on pins and address more realistic solutions such as: would the medical community pay for its own medical education? For when the answer continues to be "no", in an environment where most non-healthcare professionals (either individually, or through their employers, or occasionally even government) pay for their own continuous professional development, the only comment in our consumer-driven world amongst for-profit companies wanting to make a, er, profit, surely has to be: caveat emptor? Competing interests: My company provides educational services to healthcare professionals, medical societies and pharmaceutical companies. |
|||
|
|
|||
|
Peter H L Aitken, Director of Research & Development, Devon Partnership NHS Trust, Director www.arborvitae.org.uk Centre for Education Research & Development, Wonford House, Dryden Road, Exeter, EX2 5AF
Send response to journal:
|
Sir, With current and future UK government policy directing the NHS to work with industries of many kinds including pharma, biotech & IM&T, doctors in common with other health professionals need new critical appraisal skills to interogate marketing messages and new knowledge to understand how these industries operate to maximise their success in the health market. A group of us, senior consultants & academics have worked on this for the last three years, developing and running courses and have most recently created on line tools to help doctors and other health professionals find their level of confidence in relation to these activities. These tools are freely available at www.arborvitae.org.uk. We welcome comment on their usefulness. The site includes a discussion blog with the aim of generating peer discussion regarding ethical dilemmas presented by working at this interface. We very much welcome this BMJs focus on the issue and Ray Moynihan's article. Aitken P, Katona C. Working with the drug industry – is your reputation at risk? BMJ Career Focus 2005;330:73–5 Competing interests: Peter Aitken is a Director of Arborvitae Education which stands to gain if more health professionals train in their working relationship with the pharmaceutical industry |
|||
|
|
|||
|
Sudip Sikdar, Consultant Psychogeriatrician Waterloo Day Hospital, Park Road, Liverpool, L22 3XR
Send response to journal:
|
Dear Editor Iam responding in this column as I have been on both sides of the so called fence without compromising professional integrity. I have been paid by pharmaceutical companies to deliver talks on mental health problems in the elderly and also have attended meetings sponsored by drug companies to gain CPD point requirement for annual appraisal purposes. In the former role, I have always declared at the beginning of the talk that I was being paid and also made sure that the content of my talk had no reference to the drug manufactured by the sponser's company. As an attendee, I similarly made sure that I only attended meetings whose contents had no direct relationship with the sponser's drug. While NHS training budget is being cut every year, national and international educational meetings are becoming so expensive that trusts are finding difficult to fund a doctor to attend these meetings. Yet members of the Royal College of psychiatrists are required to gain a number of external CPD points to fulfill the good professional standing requirement. Thus it sometimes becomes an impossible balance to maintain without external help. As long as a doctor declares to their respective NHS trusts that they have been funded by drug companies to attend such meetings and they themselves choose these meetings carefully, both partners can lie side by side without feeling compromised! Competing interests: None declared |
|||
|
|
|||
|
dr vikram vinayek, consultant private sector
Send response to journal:
|
in usa perhaps there may be no free lunches but in a country like india where social-cultural beliefs are significant there have to be free lunches.lunch is only an incentive , it is a small thing. one is not asking for a BMW car, only a lunch. the output of the lunch is for all to see-education which ultimately transfers into good patient care. Competing interests: None declared |
|||
|
|
|||
|
Anthony Papagiannis, St Luke's Hospital Thessaloniki, Greece
Send response to journal:
|
Recently I attended, along with a couple of hundred other physicians, a drug-sponsored symposium. Two very good speakers reviewed for us information from several studies, all of which had been industry-funded, only to convince us that what we have been doing all along as standard practice is indeed scientifically valid. An extravagant dinner followed, and all participants were handed a completely useless but probably not cheap metal gift on their way out. Not for the first time, I wondered whether my patients would continue to trust the sincerity of my motives were they to know how lavishly I am entertained by the manufacturers of some of the products I prescribe for them. Dare I tell my next patient: "This is best for your condition, but I must inform you that I spent last weekend in XYZ resort at the expense of the company that makes it?" Would such a disclosure be to the patient's best interest? I also wondered whether all the studies reported (which were essentially duplicating each other without answering real scientific dilemmas) ought to have received ethical approval in the first place. Perhaps the medical community should reconsider the value of multiple comparative trials of well established products which only aim to promote one drug or device against another. Is it possible that whoever said that "the randomized controlled trial is the graveyard of intelligence" had this particular type of study in mind? Competing interests: I admit to being fed and entertained by various drug companies from time to time, though I believe (honestly!) that this does not affect my judgment. |
|||
|
|
|||
|
Hari Prasad, Medical Research Faculty, Microbiology, K. S. Hegde Medical Academy, Deralakatte, Mangalore - 575018, India.
Send response to journal:
|
Kudos to Dr. Ray Moynihan for exposing seamy side of medical education [1].The relationship between drug companies and academic medicine is currently very close. In the recent past, major journals have expressed concern at the negative influences of pharmaceutical promotional campaigns; but ironically, many of these articles are surrounded by dozens of advertisements in the Journal [2]. Almost 90% of authors published in the Journal of the American Medical Association have received research funding from, or acted as a consultant for, a drug company [3]. Majority of medical students have no idea that even their textbooks are written with the help of money that comes from drug companies [4]. In developing countries like India, virtually no departmental support is available to undertake research, hold conferences, symposium and scientific meetings, and hence, increasingly, external funds are necessary. The pharmaceutical industry has been a relatively dependable source of funding — if the doctor is prepared to mug-up a topic of interest to the potential sponsor [5]. No matter, how positive the support of the pharmaceutical industry on academic medicine the fact remains that the drug-company money is a slippery slope. It is well to remember that the costs of the industry- sponsored trips, meals, gifts, conferences, and symposiums and research grants are simply added to the prices of drugs and devices. I hope doctors take the time to reflect on the direction in which this is taking us. Finally, I would like to congratulate the Journal's courage in bringing this debate to the stage of mainstream medical discourse. This brief communication concludes aptly with the words of Aristotle “truth could influence only half a score of men in a century, while falsehood and mystery would drag millions by the nose”. REFERENCES: 1.Moynihan R. Doctors' education: the invisible influence of drug company sponsorship. BMJ 2008; 336(7641):416-7. 2.Hagan BM. Is Academic Medicine for Sale? N Engl J Med 2000; 343(7):508-10. 3.Healy D, Thase ME. Is academic psychiatry for sale? Br J Psychiatry 2003; 182:388-90. 4.[Anonymous]. Drug company influence on medical education in USA.The Lancet 2000; 356:781. 5.Lal A. Pharmaceutical drug promotion: How it is being practiced in India? J Assoc Physicians India 2001; 49: 266–73. Competing interests: None declared |
|||
|
|
|||
|
Luisella Grandori, paediatrician 41100 Modena, Italy
Send response to journal:
|
We are an Italian No free lunch group, called “No grazie pago io!” (No thanks, I will pay). We agree to end drugs companies’ direct sponsorship of doctors’ education, because, as Des Spence says, “it is marketing masquerading as education”. Surveys and reviews of evidence that he mentions, are significant. We think doctors’ and all health workers’ education – as citizens’ information about health and drugs – shouldn’t be sponsored by drugs industries, but carefully protected from any other interest than our primary one: protecting people's health. Education is the core of doctor’s activity and it is the primary information on which he/she bases his/her approach to illness and therapy. Nevertheless education has a strong impact on health for both patients and National Health Service (NHS). Our proposal is that doctors’ education should be founded by NHS. In order to protect citizens’ health, governments should invest on doctors’ independent education, for example using taxpayer grants, as Peter Mansfield suggests. Moreover education could be paid partly from doctors, for example the independent newspaper La Revue Préscrire is directly paid from French doctors who want unbiased information. Luisella Grandori Paediatrician, Modena, Italy spokeswoman of "No grazie pago io!" www.nograziepagoio.it Competing interests: None declared |
|||
|
|
|||
|
Deborah H Yates, Thoracic physician Sydney, Australia, Paul S Thomas
Send response to journal:
|
We were pleased to read the paper by Moynihan and colleagues and its accompanying editorial. This topic has been examined in several areas (1,2); what is missing is appropriate action. Medical education is too important to allow even a possibility of bias and the case for a central impartial fund for postgraduate medical education is growing. Were one established, however, careful thought would need to be given as to how to ensure its independence. It is disturbing to see that, again in a study from Australia, a survey of 302 public health academics from 17 health research institutions reported that 81% believed suppression of research had occurred which protected government interests (3). We should not forget those influences outside the big pharmas, which may be less obvious and even more insidious. References 1. Thomas PS, Tan KS, Yates DH. Influence of funding upon outcomes of research in asthma and rhinitis. Lancet 2002; 359:351. 2. Thomas PS, Tan KS, Yates DH. Sponsorship, authorship and accountability Lancet 2001;854-6. 3. C D'Arcy Holman. Aust NZ J Public Health 2007;31:551-57. Competing interests: None declared |
|||
|
|
|||
|
Marty Cearnal, Executive VP and Chief Strategy Officer Jobson Medical Information, 1515 Broad Street, Bloomfield NJ 07003 USA, BradBednarz, Mark Schaeffer
Send response to journal:
|
By Brad Bednarz, Marty Cearnal, and Mark Schaffer Brad Bednarz is chief strategic officer, Visible Productions (visiblep.com). Marty Cearnal is executive VP & chief strategy officer, Jobson Medical Information (jobson.com). Mark Schaffer is VP, CME compliance, Professional Postgraduate Services (ppscme.org). Mr. Bednarz, Mr. Cearnal, and Mr. Schaffer are co-chairs of the CME Committee of the Coalition for Healthcare Communication (cohealthcom.org). In the USA, Certified CME is Different Readers should know that while continuing medical education (CME) in the US may not be perfect, government, the professions and industry have taken significant steps over the past decade to insure both independence and quality in “certified CME.” Rather than ignore these steps, international critics and supporters alike may choose to learn from them, even emulate them, to improve their own systems. Since 1997 when a U.S. Food and Drug Association guidance document called for clear separation between promotion and education in the US, the CME community has made consistent improvements. Changes in the organization, structure and oversight of CME activities have all been directed toward assuring independence from commercial influence, the highest scientific standards for content and measurable improvements in patient outcomes. The initiative has been embraced and supported by industry and providers, and moved forward by the leading US accrediting organization, the Accreditation Council for Continuing Medical Education (ACCME). While some worry that many of the changes, including those driven by ACCME, are expensive and interfere with constructive cooperation within the CME community, most professionals agree that the current environment demands strong action to demonstrate commitment to resolution of even perceived problems of conflict of interest and to improve the quality of all CME. Pharmaceutical manufacturers have done their part by taking extraordinary steps to assure improvements by naming compliance officers and developing strict compliance policies, including creation of education groups and grant review committees independent of sales and marketing. All stakeholders have cooperated in other reforms. Lavish meals and entertainment are gone. Supporters no longer recommend faculty and venue. Most important, supporters no longer review educational content. In addition, over the next several months, every education company that is part of a larger company must restructure if it is too closely affiliated with a unit that does drug marketing. The CME company must operate free of all control and influence from the marketing segment of the company. CME companies are responding with urgency and most will complete the process well before the deadlines set by the ACCME. In summary, US providers and industry have taken and continue to take aggressive steps to insure that healthcare professionals are offered independent and unbiased CME. This is “certified CME” and it is different than that offered in much of the rest of the world. We recommend that these efforts to avoid bias and influence be widely adopted throughout the international CME community. We believe they help assure both physicians and the public that “certified CME” offers the most objective and scientifically rigorous medical information available to the healthcare community and will advance the health of patients throughout the world. ------------ Interested parties can respond directly to authors by e-mail: bbednarz@visibleproductions.com; mcearnal@jobson.com; mark.schaffer@ppscme.com Competing interests: Authors are executives in for-profit organizations that provide education services in the United States. |
|||
|
|
|||
|
Anthony N Fleg, National PharmFree Coordinator, American Medical Student Association 27516
Send response to journal:
|
I appreciate the recent article on the industry-favorable influence of industry sponsored "education." But, as a medical student who has listened closely to the professed ethics of my profession - evidence- based, patient-centered, cost-effective, Hippocratic - I would hardly call the influence invisible. In fact, I take it as a offense to our collective intelligence, and as a symptom of the degree to which the pharmaceutical industry has influenced our language around what counts as "education." A few questions to consider: Why would pharmaceutical companies pour $7 billion dollars into advertising to...excuse me - "educating" - physicians in the U.S. alone if it were not an incredibly profitable endeavor? Why would any pharmaceutical company spend money on "education" that did not increase the company's return to shareholders? Given that they are for-profit companies, wouldn't that be a poor business decision? Why are physicians so vehemently offended by the notion that industry "education" is biased and an interference into the duty of the physician to do what is best for her/his patients despite the studies that clearly link company "education" (which almost always comes with some gifts to help clinicians remember the "educator") to changes in prescribing behavior? Would we have this same conversation around "education" from car dealers, clothes companies and other for-profit entities? Would we feel the need to expose the invisible influence of the "education" from the Mercedes dealer on the subject of "The best cars on the market?" Is discussing the invisible influence of Nike "educational" ads on the best shoes to wear necessary? I am proud to say that a large and growing cadre of physicians-in- training in the U.S. have joined the PharmFree campaign (www.pharmfree.org), which aims to rid medicine of the VERY visible influence that industry "education" has on clinicians, the patients of these clinicians, and the larger health care system. The campaign was the American Medical Student Association's cure for the addiction to industry influence that so infiltrates medicine today, following the organization's move to become the first national medical organization in the U.S. to divest from pharmaceutical funding. PharmFree physicians-in-training pledge to take no gifts (lunches, pens, etc) from industry, and to seek unbiased sources for their education. In doing this our mission is simple: RECLAIM the ethics of medicine by, REMOVING conflicts of interest, and RECLAIMING the sanctity of the patient-physician relationship I would close by simply saying that we must not kid ourselves by using terms that suggest that industry influence in its "education" and other attempts to influence physician behavior is anything but obvious, visible, and blatantly violating of the trust relationship between patients and physicians. Anthony Fleg, MPH UNC Chapel Hill National PharmFree Coordinator, American Medical Student Association Competing interests: None declared |
|||
|
|
|||
|
Manthan D. Janodia, Lecturer, Department of Pharmacy Management, MCOPS, Manipal 576104, Karnataka, India, D.Sreedhar, Virendra S.Ligade, N.Udupa
Send response to journal:
|
This is with reference to Ray Moynihan's Article on Doctor's education. It is not surprising to know the fact that drug companies do have visible or invisible influence on doctor's education. Every doctor who is attending a symposium, seminar or a conference that is sponsored by drug companies would be having some kind of "positive" influence in prescribing medicines of event sponsoring companies. This is applicable to all countries alike where an event on doctors' education is sponsored by drug companies. It would be foolhardy to believe that doctors' who attend any event, which is aimed at "educating" them, does not understand the veiled motive of the sponsoring company. Once a pharmaceutical company suggests the name of a speaker, it is understood that those speakers are the "brand ambassadors" of company sponsoring the event; these brand ambassadors albeit promote company's brand surreptitiously. The blame does not lie entirely with the pharma companies. When a doctor is attending an event of “education” sponsored by a pharmaceutical company, it would be onus on the part of doctor not to get influenced while prescribing a brand that was “recommended” covertly in an “educational event”. As a learned class of people, doctor’s can have their own judgement while prescribing medicines. Companies do it to recover the money that they have invested in marketing and building "brands". Moynihan has pointed out case of two countries Australia and the UK which are so called “developed” countries. If such is the situation in these developed countries, imagining a situation in “developing” countries is anyone’s guess where rules and regulations are either lax or flouted with the help of financial power of companies. What is required is the effort on part of sponsoring companies to take a neutral stance and allow the organizers to decide the speakers without influencing them Competing interests: None declared |
|||