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US Senate committee investigates conflicts of interest in industry funded medical education

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3139 (Published 04 August 2009) Cite this as: BMJ 2009;339:b3139
  1. Janice Hopkins Tanne
  1. 1New York

    Prominent academic doctors and a medical students’ leader have criticised continuing medical education funded by industry at a hearing of the US Senate Special Subcommittee on Aging.

    However, a representative of the accrediting group defended its work. Murray Kopelow said that his group had recently put in place stronger guidelines on industry funding.

    The Senate committee’s hearing, chaired by Herb Kohl, a Wisconsin Democrat, on 29 July 2009, focused on conflicts of interest in the continuing medical education courses that most US doctors have to take.

    Industry funding for accredited continuing medical education increased from $302m (£180m; €210m) in 1998 to $1.2bn in 2006 and accounts for about half of the funding for continuing education.

    “Large corporations do not typically spend these sums unless they think they will get something out of it,” Senator Kohl said. Senators Kohl and Chuck Grassley, an Iowa Republican, are sponsors of the Physician Payments Sunshine Act, which would require medical drug and device makers to publicly report their payments and gifts to doctors.

    The hearing focused on creating a divide between funding and information provided in continuing education.

    During the discussion, the senator Mel Martinez (Republican, Florida), the senior Republican on the committee, said that as a lawyer he was surprised that doctors receive continuing medical education at low cost or for free. Lawyers pay for their continuing legal education programmes. Why, he wondered, couldn’t professional organisations provide unbiased medical education while drug and device companies could invite doctors to seminars about their newest products?

    Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said that continuing medical education had “grown into an enormous industry with extraordinary influence over the practice of medicine . . . [it] has become an insidious vehicle for the aggressive promotion of drugs and medical devices.” He said that the “lucrative” process had undermined the independence of medical societies, which have accepted industry funding and concealed payments to doctors. The continuing education “marketing machine” contributes to the United States’ high medical costs, he said.

    Lewis Morris, chief counsel for the Office of Inspector General of the Department of Health and Human Services, said that often drug and device companies have used continuing medical education courses to promote “off label” uses for their drugs.

    Jack Rusley, a fourth year medical student at the Alpert Medical School of Brown University in Providence, Rhode Island, said that he was the current director of the 62 000 member American Medical Student Association’s PharmFree Scorecard, which assesses conflict of interest policies at academic medical centres. Mr Rusley said that his organisation believes in disclosure of industry-medicine relations and no industry funding for continuing medical education.

    The Harvard professor Eric Campbell, who served on the Institute of Medicine’s committee on conflict of interest, said that the institute’s report calls for a way to fund continuing education free of industry influences.

    James Scully, medical director of the American Psychiatric Association, described how his association had separated commercial and educational activities.

    The Accreditation Council for Continuing Medical Education, which sets standards for continuing medical education, is a “toothless watchdog,” said Dr Nissen.

    Dr Kopelow, head of the council, countered with a long statement defending his organisation and describing stronger guidelines that the organisation had recently set in place.

    Thomas Stossel, a senior doctor in translational medicine at Harvard Medical School, also defended industry funding of continuing medical education and of advertising directly to the public. He said that there is little evidence of corruption and evidence of benefit in informing doctors and the public.

    Notes

    Cite this as: BMJ 2009;339:b3139

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