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The Lancet 2000; 356:781 DOI:10.1016/S0140-6736(00)02645-3 Drug-company influence on medical
education in It begins on the first day of medical
school and lasts through to retirement, and it is the only reliable “cradle
to grave” benefit that doctors can truly count on any more. Even in this era
of medical-ledger watching world wide, there is little evidence to expect it
will ever end. In fact, it may even be growing. It starts slowly and
insidiously, like an addiction, and can end up influencing the very nature of
medical decision-making and practice. It first appears harmless enough: a
textbook here, a penlight there, and progresses to stethoscopes and black
bags, until eventually come nights “on the town” at academic conventions and
all-expenses paid “educational symposia” in lovely locales. Attempts to influence the judgment of
doctors by commercial interests serving the medical-industrial complex are
nothing if not thorough. Unfortunately, they seem to work. Studies have shown
that prescribing patterns are influenced by advertising and other marketing
activities. If this were not the case, why would industry spend hundreds of
millions of dollars on promotion? Advertising sustains industry, and no
industry, not even the medical one, can avoid its reach. So it is not the
fact of marketing that is in question here. It is the form in which it comes.
Surely, no one would mistake a pen with a corporate logo as anything but
promotion. Nor would anyone suggest that a stuffed animal with a brand-named
drug stitched to its fur is of great medical value. But when the line between
medical education and advertising or marketing is blurred, there is a
problem. A recent study completed by the Of the 43 companies that answered
questions on finances, total revenue amounted to $643 million in 1999 alone,
a 19% increase from 1998. Extrapolating this to the entire industry, Public
Citizen predicts that the MESS industry is worth at least $1 billion
annually. An astounding $115 million was billed by MESS to their clients on
grand rounds alone; $114 million on symposia, $64 million on advisory boards,
and another $60 million on publications. 68 (85%) of MESSs
provided data on their client mix. On average 76% of respondents' clients
were drug manufacturers. 26% of the MESS reported that at least 90% of their
clients were pharmaceutical companies. It cannot be said that the quality of any
of these educational activities was compromised by the ultimate patronage of
the pharmaceutical industry. Indeed, 43% of the 80 MESS respondents reported
being accredited by the Accreditation Council of Continuing Medical Education
(ACCME) and an additional 5% said their accreditation was pending. Of course,
that also means that over half of the MESS surveyed do
not have ACCME accreditation. While one cannot be certain that lack of
accreditation necessarily connotes poor educational quality, it does at least
suggest the possibility that industry may be able in these situations to
exert even greater influence over what material is presented and what is left
out. What is of most concern here is the fact
that so much continuing medical education comes through the filter of
industry. To ensure the integrity, and the appearance of integrity, of the
process of learning in medicine, physicians should do more to pay for CME themselves,
just as many other professionals have to do. The Lancet |
