End the scandal of free medical educationBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3936 (Published 19 June 2013) Cite this as: BMJ 2013;346:f3936
- Des Spence, general practitioner, Glasgow
I am wary of the too kind, the too good looking, the too generous, the too polite, the too thin, and the too earnest—because they are always fake. Gullibility is a flaw in medicine, because our job is to give patients what they need, not what they want. Doctors believe their intelligence protects them from pharma marketing but are in complete denial. Doctors follow the herd and are in thrall of the mob.
Big pharma spent £40m last year supporting “educational activity” for health professionals.1 Why? Because sponsored education is just marketing masquerading as education, with the sole intent of influencing doctors. Medicine is a hierarchy, with doctors conditioned to be deferential and to follow orders. So pharma exploits this weakness. It pays hard cash to omniscient and omnipresent preaching specialists. Local consultants are influential, but the international specialist is medicine’s infallible pontiff. And the gravitas of a specialist is measured in research publications, and these in turn are in the gift of big pharma. Many of medicine’s world opinion leaders were anointed by pharma. Experts publish in leading journals, talk on the television, advise governments, work for charities, and sit on international guideline groups.
At a local level, pharma education is about getting access to doctors and establishing personal relationships with pharmaceutical representatives. Big pharma still provides international travel, accommodation, and hospitality to NHS doctors, all hidden from public scrutiny, and this is unacceptable.
The world is changing, with education moving online. Big pharma is on the case, offering free continuing medical education created by third parties, such as sponsored BMJ Learning modules.2 But these independent third parties may become dependent on pharma’s financial support, which will potentially erode independence. Educational sponsorship is about controlling the medical agenda and endorsing a blind therapeutic mindset. It is free medical education sponsored by pharma that has helped spawn overtreatment, polypharmacy, medicalisation, and high costs.
What if pharma didn’t provide education? Radically, doctors could pay for education themselves. We might think twice about jetting off to Florida if we paid personally. Alternatively, education could be provided through easy, cheap and cheerful online modules, forums, and lectures commissioned by the NHS. Also we should have more small local groups for self directed learning. What are the potential levers to change this educational dependence? Firstly, the royal colleges should stop approving continuing medical education from sponsored meetings. Secondly, the General Medical Council should insist that all doctors publish payment and hospitality received as a requirement of registration. Free medical education is too sweet to be wholesome.
Cite this as: BMJ 2013;346:f3936
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
Follow Des Spence on Twitter @des_spence1