Healthy Skepticism Library item: 19784

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: Magazine

Smith D
Relationship anxieties
Australian Doctor 2006 July 21

Abstract:

Drug company dominance of CPD raises concerns.

Full text:

Over a recent 12-month period I saved all the invitations I received to attend CPD “functions”. These totalled 75. Sixty-four were sponsored by a pharmaceutical company and all but two of those were sponsored by by a company that manufactured a drug for the treatment of the condition under discussion. All of the 64 were free and all included a meal.
Had I attended all the pharmaceutical-sponsored functions, I would have earned at least 183 CPD points that year, well over the RACGP requirement for that triennuim.
An editorial in the Canadian Medical Association Journal in 2004 asked whether the harm from allowing CPD to be orchestrated by the pharmaceutical industry outweighed the benefits of being able to offer it at reduced or no cost. In the US in 2004 pharmaceutical manufacturers spent more than $US1 billion directly on CPD for US physicians – more than half of the total spent on CPD in the US that year – and a survey of physicians conducted by the pharmaceutical industry showed that educational seminars ranked highest in effective drug sales tactics.
Comparable data for Australia are not available, but it is plain that little CPD is available to GPs that is not financed directly or indirectly by the pharmaceutical industry. The dominant format is that the industry chooses the topic and provides the speaker and a meal.
Sponsored CPD is a significant but not always recognised form of gift giving. Gifts create obligations and influence, both directly and indirectly. The giving and receiving of gifts has a well-recognised role in most cultures. Gift-giving is a way of establishing a relationship or of reaffirming an existing relationship. The significant problem here is that obligations always flow from relationships and that while the obligations of doctors are to their patients, the obligations of pharmaceutical companies are to their shareholders. The interests of patients and shareholders are not always congruent. This has resulted in the pharmaceutical manufacturing industry being accused of disease mongering. Publication bias and the better outcome of industry-sponsored drug trials were the subject of a paper in the BMJ in 2003. And questions have been raised as to whether commercial biases determine the content of medical journals, and to the problems associated with advertising in medical journals. Another paper in the BMJ found pharmaceutical companies did not always produce good-quality information to practitioners.
GPs might think their prescribing patterns could not be influenced by such forces. But the pharmaceutical companies do, and they are prepared to spend a lot of money and a large proportion of their marketing budget supporting that belief. In the US in 2000 they spent $8 billion on gifts to doctors out of a $13 billion marketing budget.
GPs should also remember that in any setting other than medical practise, the giving of gifts by the supplier of a product to agent who has the responsibility for the purchase of such products on behalf of a third party would simply be considered as bribery.
In the US a proposal has been made that industry financial support for CPD be paid into a fund which would be administered by an independent body. Critics point out that this would merely shift the resulting obligations from individual doctors to an organisation, and that such a shift would do nothing to reduce the tendency of doctors to reach for the prescription pad as their first treatment recommendation. Rather than attempting to devise ethical ways for doctors to maintain their dependence on industry funding should be recognised as formal CPD.
Doctors, pharmaceutical makers, the PBS and most importantly patients would all benefit from a greater distance between doctors and industry.
CPD is too important to be allowed to remain a gift from vested interests.
When will Australian professional bodies, in particular the RACGP, take CPD seriously, face up to these issues and examine the options?