Healthy Skepticism Library item: 13023

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

Moynihan R.
Prescription for bad judgment
The Australian 2008 Feb 23
http://www.theaustralian.news.com.au/story/0,25197,23259342-23289,00.html

Full text:

IF you’ve never been to a doctors’ educational seminar, it would be illuminating to sneak in with a friendly GP next time. Many GPs go to these events often, because to qualify for the top rates of pay under Medicare, they have to undertake a certain amount of medical education, and these seminars are a popular way of doing it.

Rather than being dry, boring affairs, these seminars often have the air of the carnival. The big attraction is the sponsors’ exhibit hall, full of intricate and colourful drug company stalls, with their smiling and sexy salespeople. Sometimes the nibbles are not too bad either.

A busy GP can escape for a while from the tension of the surgery and enjoy the food, flattery and friendship that has become the trademark of drug companies’ relationships with doctors. But when the GP leaves the exhibit hall and walks into the hallowed lecture hall, surely the sponsors have no involvement there?

One reason governments might be interested in this question is the impact these sponsored seminars have on drug prescription, most of which is ultimately funded by taxpayers through the Pharmaceutical Benefits Scheme. Studies on how these events affect doctors’ prescribing habits suggest sponsors are getting a return on investment. Doctors who attend sponsored events tend to use more of the sponsors’ drugs, which is hardly surprising. The industry also sees the seminars as a chance to build relationships with doctors.

There is a growing global debate about whether this sort of sponsorship of doctors’ education should end. This is no small issue: almost half of the education of practising GPs in Britain is funded by drug companies. The figures are similar for the US, where the pharmaceutical industry invests more than $US1 billion a year in these educational events.

There are no reliable statistics for Australia, but there is no doubt that many of the educational events are sponsored. Drug companies are bankrolling GP education in Australia with millions every year, and there are serious questions about the effects all that money has on your health. The problem is not the drugs as such. Notwithstanding the occasional scandal about side-effects, many medicines can reduce suffering and save lives. The problem here is the effect of drug company promotion on the supposedly independent education of your GP.

An investigation in Australia, to be broadcast on ABC radio tomorrow, has discovered it is not unusual for drug company sponsors to be entitled to suggest the speakers who deliver the educational content at these sponsored seminars, subject to the approval of the conference organisers. The pharmaceutical industry and leading medical educators have confirmed this. It is “standard industry practice for sponsors to be involved”, says Ramesh Manocha, convener of HealthEd, a company that organises seminars attended by more than 2000 GPs every year.

A leaked copy of HealthEd’s 2008 sponsorship brochure, which outlines what sponsors get for their money, particularly at the so-called platinum level, offers a rare insight into how sponsorship can work. The brochure states that “at each seminar, as a platinum sponsor your company can … work with us to determine a topic that is on message for your product area”. It also says that for evening seminars, sponsors can “nominate preferred speakers (whom) HealthEd then approaches and manages”. Manocha says the wording on the brochure should have been changed and that the document is no longer used.

However, it gives the year of use as 2008 and was sent to me by a drug company representative a few weeks ago.

One pharma giant, Schering-Plough, has been candid about what it got in return for investing $40,000 in sponsorship for a series of recent doctors’ seminars organised by HealthEd. In a statement, managing director Shaju Backer says “as part of the sponsorship, companies are allowed to suggest speakers and topics”, which, he adds, then undergo a peer review process to ensure they are suitable.

Schering-Plough also made public an extract from an email sent to it by HealthEd that says platinum sponsors are routinely offered the chance to “work with us to determine a speaker and topic for the program”, subject to the speaker being authoritative and scientifically balanced, and the content being evidence-based. The drug company says it sponsors such meetings to help ensure drugs are used appropriately, and stresses that no guarantee is given that the topics or speakers nominated by sponsors will be chosen; neither is a guarantee a condition of sponsorship.

Manocha strongly defends his HealthEd seminars as independent and says that although companies can suggest speakers for individual sessions, all suggestions are rigorously assessed or filtered through working groups that organise his meetings, according to stringent guidelines set by the Royal Australian College of General Practitioners.

The topics for his seminars come from surveys of GPs, he says, and many of the individual sessions are not sponsored. He estimates drug companies are able to suggest speakers for up to 25 per cent of sessions.

As The Australian reported yesterday, the drug industry’s peak body, Medicines Australia, says sponsors suggesting speakers is not unusual, but that independence at these events is maintained because the educational provider and its committees have the final say over the topics and who speaks.

However, Medicines Australia chief executive Ian Chalmers says doctors should be told if speakers at the educational events have been suggested by drug companies.

Not surprisingly, the seminars at which our GPs refresh their skills and learn about the latest research are supposed to be “completely independent of the sponsoring organisation”, according to the guidelines of the GPs’ college.

RACGP spokesperson Peter Maguire says sponsors suggesting speakers is “not really independent on face value, because often if the sponsor is a commercial entity and they want someone to speak, one assumes that they have a message that they want to come across, which clearly is not independent”.

There is a clear contradiction here. The GPs’ college acknowledges that the nature of sponsorship may sometimes undermine the independence it demands in its guidelines, yet it tolerates widespread drug company funding of these events.

The system is essentially self-regulatory and these are guidelines, not laws, so unless governments start looking at this area more closely, the status quo will likely remain.

No one is suggesting that sponsors tell speakers what to say, or that anyone else does so. The influence of sponsorship is much more subtle, potentially affecting the range of views GPs are exposed to at these seminars. As Peter Mansfield of advocacy group Healthy Skepticism puts it, you are unlikely to have sponsors suggesting speakers who will contradict their marketing messages.

Mansfield, who is an Adelaide academic, GP and long-term campaigner against misleading marketing, describes this sponsor influence as an invisible germ that many doctors can’t see affecting them. “Bias that comes from promotion is like a bacteria, in that it is invisible.”

Across the world there are growing calls for reform. In the US, Harvard professor David Blumenthal is part of an influential team that has called for an end to direct drug company sponsorship of doctors’ education. In a landmark piece in The Journal of the American Medical Association two years ago, the team suggested the creation of blind trusts, where companies collectively pool funds and educators unconnected with the industry take money out at the other end.

In Australia, Mansfield has suggested a new system of taxpayer-funded education, delivered by way of competitive grants.

Another educator, Garry Egger, says it may be time to introduce a levy on drug companies to pay for doctors’ education.

Don’t hold your breath waiting for the medical establishment to try to clean things up: too many people are eating out on the drug companies’ dollar. Even the RACGP, which is supposed to demand independence in education, seems cool on any suggestions for a clear separation between drug companies and the education they sponsor. Maguire says there “may be merit” in different funding models, but he says doctors would be concerned they might have to pay a little more from their own pockets.

“I think one of the fears of practitioners is that the sponsorship will be taken away and it will become a user-pays system, which I think would worry the profession,” he says. The more the public learn about how their doctors are educated, they may start to worry too.