Healthy Skepticism Library item: 15723

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

Swan N.
Drug company sponsorships
ABC Radio National 2009 Jun 1
http://www.abc.net.au/rn/healthreport/stories/2009/2584677.htm#transcript

Abstract:

A group called Healthy Skepticism is trying to achieve a ban on pharmaceutical company involvement in medical education.

Full text:

Norman Swan: Tomorrow in Canberra the National Health and Medical Research Council (NH&MRC) is holding a meeting about the relationship between the pharmaceutical and medical device industries and medical researchers and doctors. There’s a growing wave of change and pressure internationally in relation internationally over transparency of funding and conflicts of interest when it comes to people who make prescribing decisions or decisions about what piece of technology to put into you in an operation.

That kind of pressure was typified last week in a protest about pharmaceutical sponsorship of the National Congress of the College of Psychiatrists. The issue in particular was and is who pays for doctors’ education and that issue is not confined to psychiatry.

Dr Jon Jureidini is a child psychiatrist and head of the Department of Psychological Medicine at the Women’s and Children’s Hospital in Adelaide. He’s speaking on the Health Report today in his capacity as chair of the organisation Healthy Skepticism. And in the interests of transparency I should declare that I have chaired medical education meetings sponsored by industry.

Now back to Jon Jureidini of the Healthy Skeptics.

Jon Jureidini: It’s an organisation that’s been around for a long time and has really devoted itself to trying to counter the impact of inappropriate marketing of pharmaceuticals.

Norman Swan: What’s your issue here over medical education, what’s the extent of the problem or the issue?

Jon Jureidini: Well the extent is enormous; I mean there’s hardly any medical education that doesn’t have at least a presence of the pharmaceutical industry in it. The psychiatry congress just gone is a really good example of that where all seven sponsors of the conference, named sponsors were pharmaceutical companies and there were a number of company organised supposedly education events during the program.

Norman Swan: And you’ve got a specific issue with some of the companies involved with the psychiatric congress?

Jon Jureidini: Well it just happened this year that two of the companies who were gold sponsors have been the recent focus of publicity about their marketing of what are very dangerous drugs. And in both cases there’s been in one case a legal settlement to support the fact and fines to support the fact that serious adverse effects of the drug were being hidden. I mean in the other case there are significant documents to suggest that that’s also the case.

Norman Swan: How does it work in terms of pharmaceutical sponsorship of medical education events?

Jon Jureidini: Well it works on many levels, I mean first the companies actually just give money to support the funding of the conference and supposedly once they’ve given that money it’s up to the conference organisers how they spend it. They also pay a lot of money to have exhibition space at conferences. A lot of the registrants at a conference are drug company staff so the ones who come to man exhibition booths have to pay registration. There’s a unknown amount of doctors who have their registration paid by the pharmaceutical industry. There are symposia run at conferences which are not actually part of the core scientific program but are advertised in the program and are given space and time to operate.

Norman Swan: And the evidence of influence?

Jon Jureidini: Well there’s a range of studies that show that all of these marketing activities influence prescribing. The thing is that there are so many different activities happening at the same time that it’s really hard to tie down what the influence of any one activity is but we have to assume that companies make good decisions about how to spend their money on marketing.

Norman Swan: And overseas organisations have taken a stand on this?

Jon Jureidini: Yes, the last equivalent British congress in psychiatry was run without company sponsorship.

Norman Swan: And what happened? Because the organisers of the learned college will say ‘well we couldn’t afford to have a conference, it wouldn’t happen, nobody would come’.

Jon Jureidini: I don’t think any of those things happened. You know the reality is that we doctors can afford to pay for our own education and we don’t need to have our education subsidised in this way, particularly if it leads to distorted education that in the end might harm our patients.

Norman Swan: There’s a lot of pressure on doctors these days to maintain their continuing professional development and that’s the gap into which the pharmaceutical industry has stepped in many instances outside conferences. What would happen do you think to continued professional education and the funding of it should the pharmaceutical industry have to step aside? I’m thinking of less well paid doctors for example general practitioners here.

Jon Jureidini: I think that’s an important issue and perhaps we need to have a government level review of post graduate medical education because it has become so pervaded by drug company influence that it would be difficult to get from where we are now to somewhere where people like me would like to be without some pain, without compromising doctors and in fact enhancing the quality of the education that they’re getting. It might not be happening in quite such comfortable circumstances, I think it would be better education.

Norman Swan: So give me your vision for what it would be like in say five years time if doctors took a stand and said no more involvement in pharmaceutical sponsored medical education events?

Jon Jureidini: If the pharmaceutical industry wanted to remain involved in medical education, if it truly is an altruistic thing on their part, they would be able to give money to blind trust that could provide education without any direct acknowledgement of the company or any involvement of any products. What I would like to see is that drug company reps are replaced by academic detailers, people who are independently providing quality use of medicine information to doctors. An extension, an elaboration on what the National Prescribing Service currently does and has just been given more funding by the government to do in the future. I think that doctors could have as rich, or a richer range of medical educational opportunities but they might not be happening over expensive dinners in high class restaurants.

Norman Swan: Do you want to give any examples of where you think there have really been worrying examples of things happening?

Jon Jureidini: There are some really good examples from within psychiatry of this, I guess the one pertinent to the concerns raised about the current congress are the expansion of indications for the use of so called anti-psychotic drugs out of the area of the treatment of psychosis and into general practice. In terms of marketing opportunity if you can find a justification for using these expensive drugs for non-psychotic patients your potential population of patients expands enormously and if you can convince general practitioners that they should be prescribing these drugs and not restricting it to psychiatrists then you radically increase the population of prescribers that you’ve got.

There are countless examples of what’s presented in the name of education is in fact an attempt to expand the use of anti-psychotic drugs into these inappropriate market.

Norman Swan: And this is particularly people with dementia.

Jon Jureidini: People with dementia, children with behavioural problems and also in the years inbetween those two populations, people with a range of presentations that we’re increasingly being invited to understand as being bipolar disorders. And we are increasingly being asked to think of so called anti-psychotic drugs as mood stabilising drugs to be used with people with bipolar disorder. What’s being done there is that we’re stretching the diagnostic boundaries for their limit or beyond their limit really, and we are stretching the indications for the drugs beyond their limit and the intersection of those two expansions is potentially an enormous increase in the market for anti-psychotic drugs.

Norman Swan: Dr Jon Jureidini of Healthy Skeptics and also the Women’s and Children’s Hospital in Adelaide.