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Posted on Thursday 24 June 2010

hat tip to ShrinkRap
Debate Over Industry Role in Educating Doctors
New York Times
By NATASHA SINGER and DUFF WILSON
June 23, 2010

In the latest effort to break up the often cozy relationship between doctors and the medical industry, the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses. University officials voted to eliminate commercial financing, beginning next January, for postgraduate medical education, a practice that has come under increasing scrutiny from academics, medical associations, ethicists and lawmakers because of the potential to promote products over patient interests.

Dr. James O. Woolliscroft, dean of Michigan’s medical school, said leading faculty members “wanted education to be free from bias, to be based on the best evidence and a balanced view of the topic under discussion.” While the financing in question amounts to as much as $1 million a year at Michigan, commercial payments for industry speakers and courses nationwide come to about $1 billion, nearly half the total expenditure for such courses.

The debate over whether the medical profession should develop an industry-free model of postgraduate education is a delicate one. A conference at Georgetown University on Friday, called “Prescription for Conflict,” will highlight the arguments on both sides through presentations by federal health officials, professors from leading medical schools, hospital executives and a Senate investigator.

Already this year, the debate has led to public squabbles as doctor groups have squared off over proposals for new restrictions on industry involvement in the courses known as Continuing Medical Education, or CME. The accrediting body for postgraduate medical education, for example, recently said it would no longer grant credit to doctors for attending medical meetings that feature industry employees presenting product research. The decision was met with howls of dissent this month from some doctors, including the director of the National Institutes of Health and the president of the American Heart Association, who said it would unfairly cut physicians off from scientific knowledge.

On the other side of the argument, a leading medical ethicist asserted that the prohibition did not go far enough. Dr. Bernard Lo, lead author of a 2008 Institute of Medicine report on conflicts of interest, said private doctors and academic physicians who are paid to speak for drug companies should be barred from presenting educational material at accredited conferences. “Mouthpieces for their products,” he called them…
In a corrupt time, any glimmer of integrity tends to shine like a bright star. In this case, it’s more like the sun rising. In a series of recent posts, I’ve been focused on one example that’s very close to home, the case of Dr. Charles Nemeroff, the former Chairman of the Department of Psychiatry at Emory University, now the Chairman at the Miller School of Medicine at the University of Miami. At least in my specialty, Dr. Nemeroff lead the pack of offenders. Here is a listing of some of the recent articles about his case, and then links to searches for "nemeroff" on some of the blogs that follow these Conflict of Interest issues on an ongoing basis [the documentation is extensive]:
Continuing Medical Education started off as a good thing. Ongoing medical education has traditionally been a part of Medicine – Meetings, Grand Rounds, Journals, etc. – but it has increasingly become a requirement for ongoing licensure. So there grew up a large number of accrediting bodies and providers, and as time went on, CME was funded more and more by Pharmaceutical Companies. My own memory was that this wasn’t so much of a problem ‘way back when,’ but maybe I just didn’t notice. For the last twenty or thirty years, Medicine has become "business-i-fied" – Managed Care, HMO’s, big Pharmaceutical Companies, "designer" drugs, those horrible ads on television,  epidemic malpractice suits. It’s been a shame from my perspective. And the use of CME presentations as advertising has skyrocketed. I don’t knowingly go to Pharmaceutical Company sponsored CME meetings myself. Fortunately, I taught a lot and one can get credits that way. I’d rather teach for free than sit through an ad.

The invasion of the Pharmaceutical Industry into my specialty, Psychiatry, has become so pervasive that finding unbiased information about drugs is a lot of work. Many Textbooks and Journals are authored by people on some [or many] a company payroll. For example, the Textbook of Psychopharmacology published by the American Psychiatric Association’s Press is authored by Dr. Alan Schatzberg [Chairman at Stanford, outgoing President of the APA] and [you guessed it] Dr. Charles Nemeroff [Chairman at Emory until demoted, and now in Miami]. Both authors have been censured for conflicts of interest [or worse] in one way or another, and both were removed from NIMH Grants. They are also active on the CME circuit. I’ve never opened that book. It might be great, but there’s no way for me to trust what I read there, given the track record of the authors. Likewise, as you might guess, the invasion of medical education by industry is a huge factor in the escalating costs of medicine. The drugs being advertised are the most expensive ones, not available in a generic form, and not necessarily the best choices [in spite of what it says on the television ads]. We’re talking about many billions of dollars in sales. Finally, Psychiatry itself has been changed – becoming too heavily weighted towards pills for all ills.

So, the decision by the University of Michigan to eliminate Pharmaceutical sponsorship of its CME presentations is a breath of fresh air in a polluted atmosphere, particularly in my specialty – probably all specialties. There is no valid argument for the other side because the level of abuse is too great. Pharmaceutical Companies should be free to advertise, but need to do it out in the open, and mandatory continuing medical education should be free from their hidden agendas. I personally think that undeclared industry ties by CME presenters should be criminalized, and that may yet happen. It’s just fraud, plain and simple. At the risk of being too idealistic, the practice of medicine and its traditional code of ethics is one of the really good things about the world we live in.  It needs to be preserved at all costs. What they’ve done at Michigan is a long overdue step in the right direction…

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