doctors learn, drug firms often pay the tab
There were no free drug samples, no pharma reps schmoozing doctors in the halls, no invitations to free steak dinners.
If any pharmaceutical company staff had shown up with their ID badges on, said event coordinator Harry Smeenk, "they'd be walked out."
But while nearly invisible at the event, pharma companies were indeed big players: They paid for it.
Doctors have long been required to take continuing medical-education courses, and for years, pharma companies have footed some or most of the bill. That relationship became tainted in the '80s and early '90s - when doctors were frequently educated by being wined and dined in lavish settings while listening to speeches about a drug company's products.
Now new rules from the federal government, universities, medical-education accreditors, and the pharmaceutical industry itself are attempting to wipe out pharma influence over the content of the thousands of medical-education events held across the United States.
But it's turning out to be a difficult relationship to untangle.
"It's a matter of common sense: Why would the industry want to support continuing medical education to the extent of billions of dollars if it were not for the belief that it promotes sales?" asked Arnold Relman, former editor of the New England Journal of Medicine.
though, say they're motivated by the desire to do the right thing for
physicians and their patients.
"We believe that by providing educational grants, this improves patient care within an area where we have a research interest... . It helps patients but also helps our shareholders."
Regulations implemented last month from the organization that accredits all continuing medical education take a tough new stand: Not only do all ties to industry have to be publicly disclosed by course teachers and others, but all conflicts of interest must be resolved before the course can proceed.
For instance, expert lecturers at an accredited education course must say if they are paid drug-company consultants - and then a third, independent party must make sure the lecturers aren't plugging the company's drugs during the course.
The goal is a "firewall" between the drug industry and doctors' education, said Murray Kopelow, executive director of the Accreditation Council for Continuing Medical Education (ACCME).
So far, restrictive new rules haven't dimmed industry's interest in paying for continuing medical-education courses - which are designed to keep doctors abreast of the latest developments their medical fields.
ACCME figures show that in 2004, drug and medical-device firms and other commercial supporters provided more than half of the $2 billion raised for continuing medical education. In 1998, it accounted for just one-third of the total.
The drug firm money is dispensed in several ways. Frequently it is channeled to academic medical centers and societies that are hosting the courses. Both often insist that drug companies can't have anything to do with content.
The "Psychiatry Academy" held earlier this year at the Hilton Philadelphia City Avenue, for example, was developed and presented by Massachusetts General Hospital - the first time its psychiatry department has accepted outside commercial money for education.
Pharma companies paid $6.5 million to support the new nationally touring course, offered free to those in mental health fields. And for that, all the companies received were their names - in small print- at the bottom of course material.
"Our integrity is on the line," said Robert Birnbaum, director of postgraduate education in the hospital's psychiatry division.
Not only do drug companies pay universities to put on the classes, they increasingly pay outside companies to write them. An estimated 100 for-profit medical-education and communication companies are now producing education courses on order for the pharma industry.
Those for-profit companies, too, are accredited and supervised by the ACCME. But as physician and writer Robert Steinbrook noted in a recent article in the New England Journal of Medicine, the ACCME has only 13 full-time employees and a budget of $3 million - making it "difficult" for the organization to watch for pro-pharma bias in thousands of education courses.
After attending hundreds of courses nationwide, former New England Journal editor Relman said, "I can tell you that almost always, the company or the use of a company's drugs is being promoted."
Relman is among those calling for an end to all drug-company financial support of education courses for doctors. But that's not a popular view.
Without pharma support for education classes, top-notch speakers would be hard to come by, doctors' tuition costs would rise steeply, and universities would be hard pressed to pay for the classes, say supporters of the practice.
"The pharmaceutical industry has been a terrific friend and supporter of academic as well as nonacademic continuing medical education," said continuing medical-education authority Arnold Meyer of Temple University's School of Medicine. Temple, he said, accepts "limited" grants from drug companies, but mainly only to pay speakers' expenses at its family-practice review course.
Birnbaum of Massachusetts General said it was drug-company money that enabled the hospital to take its expert-packed psychiatry course to Philadelphia and 23 other cities across the United States. With an added satellite hookup, it was able to reach thousands more mental-health professionals who would have been unable to attend in Boston.
Cephalon contributed $2 million toward the course.
The company sponsored it because "we were looking for a program that would cover a wide range of topics in psychiatry and not just those that we were interested in," said Cephalon spokeswoman Sheryl Williams.
Also, she said, "we
are developing drugs for psychiatric disorders, so it's an opportunity
for us as a company to start building a presence in psychiatry."