The system that keeps working doctors abreast of medical developments is too reliant on drug company funding and organization and needs an overhaul, the Canadian Medical Organization Journal said in an editorial published Tuesday.The strongly worded editorial, written by the journal’s editor-in-chief, said giving drug companies such control over the continuing medical education of doctors distorts medical practice and compromises the ethical underpinnings of the profession.
The author, Dr. Paul Hebert, placed much of the blame on doctors themselves, saying they have developed a sense of entitlement to the lavish perks often paired with continuing medical education or CME programs — things like tickets to the ballet, professional sporting events, cruises or access to exclusive golf courses.
“Over the years, the powerful pharmaceutical enticements have resulted in physicians believing that strong industry involvement is not only normal but also that they are entitled to receive the benefits. This culture of entitlement is one of the most difficult obstacles to overcome,” Hebert wrote. “We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals.”
Critics of the broad influence the pharmaceutical industry exerts over medical education, medical journals and the prescribing practices of doctors were quick to endorse Hebert’s call. “Hear, hear. . . . Three cheers for Dr. Hebert,” said Arthur Schafer, director of the University of Manitoba’s Centre for Professional and Applied Ethics, adding that the current system of CME “has very little to do with education and a great deal to do with marketing.”
Although there have been efforts to crack down on some of the largesse, stories abound of doctors being offered family cruises if they agree to sit in on a few hours of lectures put on by the drug company that sponsored the cruise or CME sessions booked at world class golf courses.
“The problem is that you should always question the funding source,” Hebert, an Ottawa cardiologist, said in an interview. “Our professional ethics and our goal as physicians may or may not align with theirs. And what we’ve done is essentially fully aligned ourselves with a business approach, if you will. By default we’ve become as a profession entitled to receive all these gifts and all this support.”
The regulatory bodies that license doctors require them to keep up with medical advances. Each dictates a set number of hours of CME credits doctors have to log every year to maintain their credentials. But while the college may be counting a doctor’s credits, there is no guarantee they are actually learning useful information in these sessions. “There’s no requirement for testing at any of this. I mean basically for many of these things, all you’re required to do is show up,” Hebert said.
Nor is there any guarantee the information is balanced. Critics of the system suggest an industry-funded CME session on managing obese patients is more likely to focus on weight loss drugs than on lifestyle changes needed to lose weight and keep it off.
Hebert’s editorial suggests that evidence shows education sponsored by drug and device makers “frequently distorts the topic selection, embellishes the positive elements of studies and downplays the adverse effects” — focusing attention on drug treatments and away from disease prevention, health promotion and non-pharmaceutical options, such as talk therapy for depression.
Hebert’s editorial proposes that an arm’s-length “Institute of Continuing Health Education” be set up to design and run continuing education programs. It suggests funding could be derived from governments, the medical profession and a levy on profits from drug and medical device patents. It called on the Canadian Academies of Health Sciences — perhaps in conjunction with its U.S. counterpart, the Institutes of Medicine — to start talks with stakeholders about how to change the system.
This type of change is long overdue, critics suggested. “They’re on the gravy train,” Schafer said, speaking of physicians. “They don’t want to get off. They deny that they’re influenced — all of them do deny that they’re influenced. And I think that’s going to be the challenge.”
Also enthusiastic about Hebert’s editorial was Dr. Gordon Guyatt, an outspoken critic of the pharmaceutical industry’s efforts to influence doctors. Guyatt spearheaded a successful campaign to bar drug company representatives from meeting with and buying perks for medical students at McMaster University in Hamilton in the early 1990s. A study later showed McMaster-educated doctors were more skeptical of information presented by drug company representatives and were less likely to agree to meet with them than graduates of a program that didn’t limit contact.
Guyatt, who continues to teach at McMaster, praised the editorial for taking aim at the “enormous” and “pernicious” influence the pharmaceutical industry has over the continuing education of doctors. But he too said the fault for accepting the status quo lies with the profession. “I don’t think you can blame the industry. I think the industry (is operating) within the structure of our society. And if we say these should be for-profit firms … industry is behaving as it should in terms of satisfying the needs of its shareholders. … It is the clinicians who have a real ethical problem with the way we’re handling things,” he said.
The editorial noted that in the United States in 2006, US$2.6 billion were spent on continuing medical education for doctors, of which US$1.45 billion came from drug or device makers. It noted corresponding figures for Canada are not available, but said there was “no evidence that the situation is any different here.”
-with a report from CP