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Editor's Choice

Big subjects: education and obesity

BMJ 2008; 337 doi: (Published 27 August 2008) Cite this as: BMJ 2008;337:a1448
  1. Jane Smith, deputy editor
  1. jsmith{at}

    We might look back on the 2000s and see them as the time when medical education really did begin to lose its dependence on drug company funding. A cluster of articles in this week’s issue suggests a groundswell of change from around the world.

    In the United States the Macy report, published earlier this year, recommends that organisations providing accredited continuing medical education should stop receiving funds from drug and device companies. Suzanne Fletcher, who chaired the committee that wrote the report, acknowledges that this process will probably take several years and “will also take professional leadership” (doi: 10.1136/bmj.a1023). Although the recommendation was made on ethical grounds, she points out that much industry funded education is based on lectures—which “we have known for a long time are not the best way to learn.” Instead, the report recommends practice based learning and improvement.

    In Italy Alfredo Pisacane offers practical experience in doing what Macy suggests (doi: 10.1136/bmj.a973). In the past five years he has organised educational events at a university hospital with no drug company funding. He has done so by running small group, team based education sessions based on an assessment of needs and aimed at improving practice. These take place locally, cost little to run (because no travel or accommodation is needed), and can be funded by health authorities, sometimes supplemented by a modest contribution from the participants (€50).

    Pfizer also seems to be following the wind: it is reducing its expenditure on medical education and channelling more of it into educational programmes run by academic institutions, societies, and hospitals. Mark Gould discusses the implications of this move for continuing medical education in the United Kingdom—where about half of such education is funded by industry (doi: 10.1136/bmj.a1399). He quotes a UK industry spokesman who points out that the UK pharmaceutical industry has, unlike the US, had a code of practice on funding education for over 50 years, but even he concedes that in future industry is likely to contribute to a pool of funding for postgraduate centres, with no say over subjects or speakers.

    In Australia too individuals are trying to abandon industry funding. Ray Moynihan tells the story of a group of psychiatrists in South Australia who tried to remove such funding from the Royal Australian and New Zealand College of Psychiatrists’ 2009 congress (doi: 10.1136/bmj.a925). They failed, but the issue is clearly now on the college’s agenda. As Robert F Woollard concludes in his editorial on the Macy report (doi: 10.1136/bmj.a119), its recommendations are important because “the current unsystematic and casual approach to much of continuing education fails to meet the standards . . . that society expects of professionals.”

    Elsewhere in this issue are two articles to counter our moral panic about obesity. Firstly, a Japanese study suggests that overweight children do not necessarily grow up to be overweight adults (doi: 10.1136/bmj.a802)—though Tom Lobstein cautions that Japanese children are not fat by Western standards (doi: 10.1136/bmj.a669). Secondly, Theodore Dalrymple reminds us of Falstaff’s plea for difference in Henry IV, Part I (doi: 10.1136/bmj.a1417): “Banish plump Jack and banish all the world.” He says, “A world deprived of foolishness, of gaiety, of non-conformity . . . would be dreary indeed.”


    Cite this as: BMJ 2008;337:a1448

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