Healthy Skepticism Library item: 11060
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Do companies too strongly influence medical education?
St. Louis Today 2007 Aug 1
http://www.stltoday.com/stltoday/business/stories.nsf/healthcare/story/1253D830FA182E6E8625732A005BD412?OpenDocument
Full text:
PHYSICIANS SHOULD EMPLOY HEALTHY SKEPTICISM TOWARD SPONSORED PRESENTATIONS
Dr. Thomas F. Hastings, internist with Esse Health and associate medical director, Essence Health Plan
Whether a blatant television commercial or a subtle sell via a continuing medical education course, drug-company marketing efforts can conflict with best-evidence treatments, and physicians should maintain their independence, review the research and trust only treatments that have been proven.
This is a daunting challenge because more than 60 percent of continuing medical education is funded by the pharmaceutical industry. Biased presentations, lacking fidelity to best-evidence treatments, are a growing epidemic. Advertisement
An important study conducted by two Harvard Medical School researchers was published in 2004 in the Journal of the American Medical Association. The study details the economic impact associated with following non-evidence based regimens when prescribing medicines for hypertension.
The study found that had proven regimens had been followed for treating all elderly hypertensive patients, American taxpayers would have saved $1.2 billion in medication costs. Far greater savings could have been achieved with fewer strokes, kidney failure, and heart attacks had best-evidence treatments been followed.
Further, the Journal of Education in the Health Professions published a 2002 study of continuing medical education that suggests financial support by industry should be separate from curriculum development. In this model, business has the opportunity to support continuing medical education while physicians can better trust the information shared.
Physicians should employ healthy skepticism toward sponsored presentations and should never change treatment without reviewing unbiased information.
While pharmaceutical companies and device manufacturers invest millions in supporting their brands, many billions could be saved by following the evidence.
PHYSICIANS MUST EVALUATE AND BALANCE INFORMATION RECEIVED IN PRESENTATIONS
Dr. Bruce Walz, committee chairman, St. ÂLouis Metropolitan Medical ÂSociety, and a SLUCare radiation oncologist
Medical companies contract with respected physicians to make presentations about a disease or problem treated with their medication or medical device. The doctors making these presentations are compensated and supported in preparing the presentations.
A benefit of this kind of continuing medical education is that physicians and surgeons are more likely to remember important details about the drug or device. The problem is the presentation may not be balanced, and valid competing superior technologies may be ignored.
Sometimes a medical salesperson comes to the physician’s office to make a presentation. Frequently, a meal is brought to be shared.
However, the American Medical Association and other governing organizations have presentation incentive guidelines. Some incentives are banned outright.
Was the presentation balanced? Are competing medications or devices even mentioned? The FDA controls what drug and device salespeople can say. While misinformation is rare, important data omissions can occur.
Is an incentive sufficient bribery to result in the practitioner feeling obligated to “repay” the favor? I don’t believe medical professionals feel an obligation to prescribe a specific medicine or medical device because of a gift.
Alternatives to company-sponsored continuing medical education are the traditional hospital/medical school grand rounds and seminars. Local and nationally recognized authorities present programs. If speakers are paid, it is by the hospital or medical school. Conflicts of interest must be disclosed and attendees are asked if there was commercial bias. This format promotes unÂbiased programs.
Corporate sponsorship is here to stay. The medical practitioner should evaluate and balance the information.
TO AVOID CONFLICTS OF INTEREST, POLICIES SHOULD BE UPDATED AND NO GIFTS ALLOWED
Dr. Larry J. Shapiro, executive vice chancellor for medical affairs at Washington University and dean of the School of Medicine
Pharmaceutical companies, medical device makers, hospitals and medical schools share the goal of improving the health and well-being of society.
As companies develop new drugs and devices, their representatives need to share that information with physicians. Moreover, the research that leads to development of new drugs and devices or that establishes their effectiveness is often carried out collaboratively by academic medical centers and corporations.
However, teaching/medical institutions recognize that a distinction must be made between marketing and conveying information.
We need to ensure that commercial promotion and business-development activities do not unduly influence medical decision-making. There have been instances of abuse, and so a number of medical schools (including Washington University) are developing updated policies.
These policies aim to halt perks to physicians for prescribing a company’s products. We do not allow physicians to accept gifts from companies. Studies have shown that even trivial gifts can have an impact on behavior.
Pharmaceutical companies need to be mindful that industry-supported educational programs remain under each school’s exclusive control, and that they contain no promotional materials.
In addition, information provided to a student or trainee by a company representative should be in the presence of a faculty member and be limited to scientific and technical information about a drug or device.
As we update our policies, we also need to nurture academic-industry collaboration in medical discovery and scientific advancement.
Industry does a lot. Society depends on our partnership to develop new products and drugs.
