The current system of continuing health education—sponsored largely by an industry with a vested interest in promoting its products—is unacceptable to self regulated health professionals, says the journal of the Canadian Medical Association.
The CMAJ editorial says that health professionals should take over medical education and base it on their needs and those of their patients (doi: 10.1503/cmaj.080317).
“It is time to stop the pharma-driven ‘free lunch’ approach and place our continuing medical education system firmly in the hands of unbiased and qualified people, not corporations whose main concern is the bottom line,” says the editorial, written by a team under the byline of the journal’s editor in chief, Paul Hébert.
It continues: “To make this vision a reality, we call upon the Canadian Academies of Health Sciences, perhaps involving the US Institute of Medicine, to initiate a dialogue among all stakeholders. Getting thoughtful discussion underway is the first step in fixing a truly broken system maintained by our culture of entitlement.
“Of the US$2.6bn [£1.3bn; €1.6bn] spent in the United States on accredited continuing medical education activities in 2006, US$1.45bn (60%) came from pharmaceutical and medical device manufacturers. Although there are no reliable data in Canada, there is also no evidence that the situation is any different here.
“Worldwide, IMS, a private company specializing in pharmaceutical intelligence, reports that in 2004 the pharmaceutical industry spent US$27.7bn on promotional activities, and US$29.6bn on research and development.”
Evidence indicates that education sponsored by the drug industry often distorts the selection of topics, embellishes the positive elements of studies, and downplays the adverse effects, says the editorial.
In effect the industry focuses primarily on treatments and issues related to treatment at the expense of the larger therapeutic picture, including quality of care and patient safety issues not involving drugs, determinants of health, and prevention and health promotion.
It says, “There is no doubt that the current continuing education enterprise compromises the ethical underpinnings and the reputation of the medical profession. Physicians are seen as being aligned with the pharmaceutical industry and with its commercial priorities. We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals.”
Repeated appeals for change have resulted in limited progress, but continuing medical education continues to be driven by the drug industry. Part of the responsibility resides with doctors themselves, the editorial says, who because of many years of powerful enticements from the industry believe not only that the situation is normal but that they are entitled to benefits.
“The only way out is to take ownership and reinvent the system,” the editorial concludes.