When Jack Rusley, a fourth-year medical student at Brown University’s Alpert School of Medicine completes his studies, he can look forward to periodic bouts of accredited “continuing medical education” (CME) throughout his career. These activities will keep him abreast of new medical developments, refresh his training and fulfill state requirements for maintaining his medical license.
But the bill for most of those trainings will not fall to Rusley, who testified before a Senate panel Wednesday. It will be footed by the pharmaceutical and medical device industry that invests billions of dollars in educational conferences and panels—with the expectation that it will recover the money down the line in increased sales profit.
Now, this close—and some charge too cozy—connection between medical education and industry marketing and promotion is under increasing public scrutiny. Are these accredited events—paid for by the medical industry—giving drug companies and medical device manufacturers undue influence over America’s doctors?
Rusley, a leader of the American Medical Student Organization, who testified wearing a white lab coat and tie, said that for his organization, disclosure of these financial ties is only the first step toward its goal of ensuring that continuing medical education will be free from industry funding.
As Congress hammers out proposals for health care reform, this issue has gained political traction. Rusley and other doctors and health professionals testified before the Senate Special Committee on Aging about pharmaceutical company influence on continuing medical education for doctors. Committee Chairman Herb Kohl, D-Wis., has cosponsored a bill with Chuck Grassley, R-Iowa, that would require greater disclosure of industry contributions toward continuing medical education; it’s now being considered as part of the Senate Finance Committee’s version of a health care bill. A version of the measure also was included in the House health care reform bill.
A sunshine bill for doctors and drugmakers
Known as the “Physician Payments Sunshine Act,” the measure would require pharmaceutical and medical device manufacturers to publicly report payments and gifts to doctors—including payments to doctors for consulting, promoting or participating in medical education programs.
According to the Institute of Medicine, commercial funding for accredited education events quadrupled from $302 million to $1.2 billion between 1998 and 2006. In 2007 alone, the pharmaceutical industry funded more than half of those medical educational activities, according to the national organization in charge of accrediting the courses, the Accreditation Council of Continuing Medical Education.
Educational events as disguised marketing
These doctors’ educational events have become “an insidious vehicle for the aggressive promotion of drugs and medical devices,” said Steven Nissen, M.D., chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. The events, he said, have “largely evolved into marketing, cleverly disguised as education.”
Nissen said they were troubling because “you never know where the boundary is. The problem now is that physicians will go to programs marketed as CME expecting education, and it is not unbiased at all.”
When a company foots the bill for educational courses designed to emphasize the benefits of their products over others, that is a problem, he said.
But another expert was less critical. Commercial companies make important contributions to the scientific understanding of diseases, Thomas Stossel, M.D., of the Harvard Medical School, told the Senate panel. “I want the best information. I don’t care who pays for it,” he said.
Currently, most states require doctors to participate in a minimum number of CME credit hours to maintain their medical licenses. And while they are often subsidized by pharmaceutical companies, Kohl stressed that the funding itself is not the issue.
“We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered,” he said.