Doctors’ education: the invisible influence of drug company sponsorship

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.

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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.

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

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.

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