The American Medical Association’s ethics journal has suggested reducing drug companies’ influence on doctors’ prescribing habits by stopping the companies paying for continuing medical education (CME; American Medical Association Journal of Ethics 2006;46:357-436).
Such education is required in most US states and by many medical societies. The journal devoted its entire June issue to ways to reduce or manage drug company influence on doctors.
In 2004, more than $2bn (£1.1bn; €1.6bn) was spent on continuing medical education. Medical communications companies and medical schools depend heavily on drug companies to develop educational programmes, say the authors, Dr Adriane Fugh-Berman, an adjunct associate professor and specialist in complementary and alternative medicine at Georgetown University’s school of medicine in Washington, DC, in the United States and Sharon Batt, a doctoral fellow at Dalhousie University in Halifax, Nova Scotia, Canada.
“Only CME [continuing medical education] activities that are entirely free of pharmaceutical industry funding should qualify as education,” they write.
The authors reject a previous proposal to have drug companies contribute to an education fund that would give money to programmes approved by the Accreditation Council for Continuing Medical Education. Such an idea was floated in May 2003 by Dr Murray Kapelow, the council’s head (BMJ 2003;326:1163). That, they say, would merely indebt doctors to the pharmaceutical industry as a whole rather than to individuals companies.
“Medicine is a profession, and pharmaceutical marketing is a business. The obligation of physicians is to patients; the obligation of a pharmaceutical company is to shareholders . . . Physicians are considered by the industry to be a barrier to surmount,” they write.
Through continuing education, drug companies aim to expand diagnostic categories so that more people are eligible for treatment and doctors are convinced that drugs are appropriate treatment. The company does not emphasise its own drugs, leaving that to the sales representatives. The authors say that the present system marginalises diet, exercise, and other drug-free approaches to preventing and treating disease.
Continuing education should be funded by doctors, not drug companies, say the authors. Doctors can well afford to pay for courses since they have the highest median income of all US workers, the authors say. Furthermore, the cost of continuing education is tax deductible and many federal agencies offer free continuing education.
In a rebuttal, Dr Kapelow, said that such changes were not necessary because in November the council will begin making accreditation decisions based on six standards adopted in 2004.
The standards say that the provider of continuing medical education must be free of control by a drug or device manufacturer. Anyone who might control the content of the education must have disclosed all relevant financial relationships with any drug companies. Funds provided by a drug company for educational materials must be spent on education, not on travel, hotels, honoraria, or personal expenses for anyone who is not a teacher or a participant in the educational activity.
The standards also specify that commercial promotion must be kept separate from education; product promotions and advertising are prohibited during educational activities. The content and format of the educational materials must promote improvements or quality in health care, not a commercial or business interest.
Finally, doctors taking part in the educational activity must be informed of the financial relationships and sources of support for the teachers at such meetings.
The issue is available online at www.ama-assn.org/ama/pub/category/3040.html.