After decades of offering continuing medical education classes in Boston, Harvard Medical School teaching hospital last year raised $6.5 million from Cephalon Inc., Janssen Medical Affairs, GlaxoSmithKline, and Wyeth for its 2005 program. The pool of money will allow the psychiatry department to dramatically ex pand its continuing medical education program with live lectures in 24 cities, teleconferences, and around-the-clock webcasts.
Mass. General psychiatrists said without outside funding they would have to charge doctors prohibitively high tuition. They said they have developed ways to minimize the risk that drug company money could bias classroom instruction.
"The companies don't have any input into the curriculum, and there is no ongoing dialogue throughout the year," said Dr. Robert Birnbaum, medical director of the Division of Postgraduate Education for the psychiatry department. "We're hoping this becomes a national model."
In recent years, the pharmaceutical industry has become increasingly interested in funding continuing medical education. While companies say their motive is to help educate doctors, the practice is raising concerns in the medical profession. Recently enacted rules have explicitly forbidden companies from nudging course content toward positive discussion of their drugs. But even those measures have not satisfied some critics.
Most states require physicians to take 30 to 50 hours of instruction a year to keep current on treatments and to stay licensed. Hospitals, medical schools, and media and education companies nationwide offer thousands of different courses, from hour-long lectures to weekend seminars in exotic locations. Increasingly, the courses are paid for by drug firms, allowing doctors to attend for free or to pay minimal fees.
In 2003, drug companies for the first time accounted for more than half of the total funding of courses offered by organizations accredited by the Accreditation Council for Continuing Medical Education, which oversees continuing medical education for doctors. That year, the pharmaceutical industry gave those organizations $944 million for education. Total funding from all sources was $1.77 billion.
The potential influence of drug companies on doctors' education was highlighted by a federal investigation of Parke-Davis, now owned by Pfizer Inc. According to internal company documents released as part of the probe, the company developed a strategy for marketing its epilepsy drug, Neurontin, for unapproved uses. In a report titled "1998 Neurontin Tactics," a New York advertising firm suggested that the company sponsor classes on bipolar illness to increase awareness of Neurontin's effectiveness in treating the disorder. Last year, the company pled guilty to criminal conduct and agreed to pay a $430 million fine.
Federal regulators and medical community leaders have called for stricter standards, and last year the accreditation council adopted explicit rules to protect against drug company bias in continuing education . For example, it prohibits companies from selecting faculty for courses or from advertising their products during educational activities. But critics say that even with the new rules, drug companies still set the overall agenda by funding only courses that emphasize treatment with expensive brand-name drugs, rather than courses that don't focus on profitable products, such as behavioral therapy for depression.
Mass. General's psychiatry department, one of the nation's largest academic psychiatry departments, said it discourages that practice by asking firms to fund the entire curriculum for a year, rather than individual courses.
Many of the psychiatrists who teach the courses are consultants for, or receive research funding from, pharmaceutical companies, which they disclose to their audiences as required by the accreditation council.
Dr. Jerrold Rosenbaum, chief of psychiatry at Mass. General, said the department will not earn a profit from the expanded program. Ninety percent of the drug company money will be used to pay Primedia Healthcare, a Texas-based education and training company that produces brochures, arranges hotels and food during sessions and maintains the website. But psychiatrists who teach the classes will earn extra.
In the past, the department gave course instructors credits they could put toward professional dues or books. Now, they will get paid $2,000 to $4,000 per course.
Birnbaum said that when he raises money for the program, he tells drug companies only about the general therapeutic focus of the courses, the instructors, and the types and number of activities planned. He said some companies do not request more specific information because they are eager to demonstrate that funding decisions are not based on the potential for drug sales.
Cephalon, a small
pharmaceutical company based in Pennsylvania and the department's biggest
funder, said it is developing products for anxiety and attention deficit
hyperactivity disorder, so funding psychiatry courses fits into its overall
strategy. "We fully expect to be marketing drugs in the psychiatric
market, so it helps having our name out there, and aligning ourselves
with Mass. General is a positive," said Sheryl Williams, a Cephalon