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.
Doctors in the dark
The larger concern is that doctors may not be learning about the best and cheapest treatments available. In his testimony, Nissen said he was “convinced that the multi-billion marketing machine known as continuing medical education” directly contributes to more costly medical care.
James Scully, M.D., medical director of the American Psychiatric Association, testified that for his members it was crucial to avoid “even the perception of possible undue influence” from the pharmaceutical industry, and in March 2009 the association’s board voted to phase out industry-sponsored symposia at their meetings. The decision came at a steep price—Scully estimates they will lose about $1.5 million in extra funding.
Sen. Mel Martinez, R-Fla., questioned whether new mechanisms were needed to ensure greater transparency or whether there needs to be a fundamental shift—with doctors paying for their own continuing education activities, as is common in other professions like the law.
The hearing made it clear that the jury is still out.
Drop in industry spending
The Accreditation Council for Continuing Medical Education reports that commercial support for CME dropped by about $200 million from roughly $1.2 billion in 2007 to $1 billion in 2008. The council said that it is “too soon to speculate about the causes of this drop or whether the drop represented a trend.”
Drugmakers’ role in educating doctors
The Pharmaceutical Research and Manufacturers of America, PhRMA— which represents major drugmakers—maintains that these education services are necessary to help prevent “under-utilization” of certain medicines. In testimony, PhRMA officials contended that the drug companies “are participants in the health care system, and therefore should participate in the educational process by which physicians and other health care professionals remain current.”
“The accredited continuing medical system has become far too reliant on industry funding,” said Eric Campbell at the hearing. Campbell, who worked on a recent Institute of Medicine study of the issue, said this kind of medical education leads doctors to overemphasize products at the expense of skills that need to be taught, such as improving communication between doctors and patients.
Dina Fine Maron covers health, science and politics. Her work has appeared in Newsweek, the Boston Globe and Science News magazine.