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DOCTORS are concerned that pharmaceutical industry support for continuing professional development creates bias, but are not prepared to pay to reduce this influence, according to US research.
The study, published in Archives of Internal Medicine, of 770 US health professionals attending continuing medical education courses found that 88% believed commercial support introduced bias, but only 42% were willing to pay higher registration fees to decrease or eliminate this support. (1)
Professor Philip Mitchell, head of the school of psychiatry at the University of NSW, said the research captured the “central dilemma” of how to fund continuing medical education.
“It’s a really important issue. Doctors want their cake and to eat it too. They want less industry involvement but they’re not willing to pay for the consequences of that,” said Professor Mitchell, who has written on the topic of drug company influence, including in the MJA. (2)
Professor Jon Jureidini, a psychiatrist and spokesperson for Healthy Skepticism, said drug companies should not be involved in supporting medical education at all. Instead, doctors should pay for their own education.
“We doctors have to expect to pay for our education like everyone else. We also have to move away from the idea that we can only be educated in first-class hotels. It’s absurd when other professions are perfectly comfortable paying for their own education,” Professor Jureidini said.
Lawyers, for instance, generally undertake continuing professional development which is paid for by their firm, professional society, or by the lawyers themselves.
Professor Mitchell said that doctors did pay for some education, particularly through professional colleges, but removing commercial support entirely could increase the cost and reduce the availability of continuing education.
He agreed with the American research that many doctors would not be willing to pay higher fees for pharma-free education. The research found that health professionals greatly underestimated the costs of these events.
Medicines Australia said pharmaceutical companies had a valid role to play in medical education. “Nobody knows more about medicines than the people who spend years researching, discovering and developing them,” said Deborah Monk, Medicines Australia’s senior manager.
Professor Mitchell said the most important thing was to ensure that the educational content was developed independently of any commercial interests.
Professor Jureidini suggested that a blind, pooled funding model for medical education could be used, provided those who developed the educational content were unaware of specific funding sources.
“Pharmaceutical companies never really say that they provide education in order to sell their products, so if they want to make altruistic donations they could make those to a blind fund that could administer medical education,” he said.
In recent years, Australian regulation of commercially supported educational events has tightened. The details of all hospitality associated with these events are published on the Medicines Australia website. (3)
Earlier this month GlaxoSmithKline became the first Australian company to announce that it would publish the total fees paid to doctors for speaking and consulting services. (4)
Both psychiatrists agreed that this was a positive step towards greater transparency. “I think that’s excellent. It’s healthy because if people are doing the right thing they’ve got nothing to hide,” Professor Mitchell said.
He said he had not been a member of a pharmaceutical company advisory board since 2008 and had never owned stocks in pharmaceutical companies or received retainers.
Professor Jureidini said he had not received funding from drug companies.
— Sophie McNamara
1. Arch Intern Med 2011; 171: 840-846
3. Medicines Australia: Education events reports
Posted 16 May 2011
and if I charge the patients a dollar each to fund the CME their insurers withdraw my rebates. Lawyers set their own fees, that’s how they cover their expenses. For those of you who haven’t seen the outside world, I can assure you journalists and businesspeople receive ‘educational’ money trips and grants all the time and somehow the world keeps turning.
This is a late comment as I have been in the UK – self-funded!
In the last 10 years of my career, because I practised in Melbourne’s outer east and lived in the Dandnong Ranges, getting to any educationbal function where dinner was not provided was a major hassle.
I have been grateful for such company support. It has not influenced my prescribing. [Nor did my one-ever gliding lesson paid for by a drug company back in the 1980s. Yes, I remember the company and the product, but it was never my primary choice as an antidepressant – more a niche product suited to some patients.]
As a specialist with the power to prescribe extremely high-cost drugs, I am constantly frustrated that it is impossible to attend ANY educational meeting NOT sponsored by a drug company. Advertising works; that is why the pharmaceutical companies spend so much time and effort wining and dining us. It is also notable that the reps for the highest cost drugs are most often sponsors of such events – anyone seen a rep advertising aspirin lately??? I find it hard to believe that intelligent, well educated medical professionals can delude themselves that they are not influenced in their prescribing by personable, charming and well-informed drug company reps providing hospitality.
Once the topic/s to be discussed at a one-evening lecture or at an all-day seminar are known, how much is truly added to a doctor’s knowledge that cannot be gleaned at no cost and with more efficient time use (no travel time to and fro, registration time, meal breaks, etc) from the multitude of weekly and monthly journals, other mailouts, specialist feedback about patients and the internet (in my experience, very much up-to-date)?
As I see it, my role as a doctor is medical and patient-oriented; that of the pharmaceutical laboratories, as medically-oriented as it may be, is, by its very nature – through its “door-to-door” salesmanship, its group invitations of doctors to its meetings, through its rights to advertise expensively and widely and is offer of inducements – full-groundedly entrepreneurial and commercial.
I am not inclined to subsidise businesses that could well trim their promotion techniques and expenses and quite feasibly champion their products more cheaply in terms of money and time demanded of the doctor and, possibly, retail cost to their patients. My personal preference remains the pre-arranged 15-minute appointment (and not over a company-provided lunch or with fancy freebies, apart from medication samples for patient use) to discuss a newly-released product at my surgery once – and only once – a year.
They would know quite well that by having me pay for their provision of a bit of updated knowledge at a meeting or seminar, they will, if I begin to prescribe their drug, retrieve – directly from me and less directly from my patients – more than they will have expended on me.
Doctors are not worried about who runs the sessions or picks up the bill
A few worry-wort goody two shoes bang on about it incessantly and I am in no doubt they only represent themselves
For a group paid $27 for $45 worth of professional work we are not keen on paying out any money to do what is essentially in the patients’ and communities’ interests and adds nothing to our income – most of us have had our books closed for years
Think of the rural practitioner who has to travel hundreds of kms to attend weekends, they need somewhere to stay. As most speakers are well known and honest, they declare their interests prior to start. Given the choice I won’t be attending non-subsidised meetings.
And further to Guy’s comment, we don’t seem to hear any ethical dilemmas from the esteemed members of the profession whose life centres around talking at conferences.
Drug companies run a business. Most of us in private practice also run businesses as well as serving our patients.
It is easy for full-time salaried specialists to denigrate the drug companies (and by implication those who accept drug company sponsorship).
I see nothing wrong with sponsorship of a conference provided the speakers are autonomous and independent in their presentations.
The sad fact is that a lot of research today cannot be adequately funded without drug company support. I suspect this applies to psychiatry as well as other specialties.
What is this bull about paying for our education like everyone else? Lets’ broaden the mandate of Medicines Australia to regulate all “business lunches” and dinners related to profession. This targeting of the medical profession is as insulting as it is misguided. Doctors desire what’s best for their patient and fear being legally crucified if they can be shown, in retrospect, to have not so acted. What better inducement for critical thinking? Using the bill-by-the minute legal profession as a paradigm of morality shows just how ivory-towered these salaried specialists really are.
Professor Jureidini is correct about the hotels although I’d go further. I fondly recall an excellent QLD ACEM meeting run on a shoestring & held at Darling Downs University. Wonderful! Purpose-built lecture theatres instead of craning to see and hear slides in a poorly converted ballroom or dining room.
The real harm of the drug industry has been in creating an expectation that the conference will be held in hotels at too great expense. The enormous study leave expenses paid to some full-time specialists in some states made this worse, while the decreasing level of support (secretarial help) has made the use of event planners (who profit by using expensive venues) the norm. Many hospitals now insist on sessional/VMO arrangements instead of PAYE which means that a conference is now an expense not a tax deduction and further decreases the willingness or even ability of those not employed as full-time staff specialists to match their fees.
Look a bit laterally. Support the local universities – or even the local high schools – and pay to use their venues if they are sited within reasonable reach of average vs high-end hotels. Lots of docs run excellent blogs with CME – try LifeintheFastLane.com from WA! Maybe such sites could be paid to recognise hits and activities for CME.