Continuing Medical Education Medicine
Q: Drug-company influence on medical education in USA
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
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 US watchdog Public Citizen documents the
relation between medical education activities, the pharmaceutical
industry, and medical education services suppliers (MESS), which are private
businesses that provide medical education. The study stems from survey data
published in the December, 1999, issue of Medical Marketing & Media, an industry
periodical. MM&M surveyed 123 MESS about their 1998 and 1999 operations.
80 returned questionnaires. In summary, the data suggest that supplying
medical education can, in this form, be a very lucrative exercise, whose most
consistent client is the pharmaceutical industry.
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
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. Any other ideas?
A:For all the money spent on furthering drugs as a cure, it would be nice to have doctors learn the real basics: Ayurveda, Traditional Chinese Medicine, Traditional Tibetan Medicine, Traditional Arabic Medicine, Traditional Egyptian Medicine. These ancients started with whole fresh foods and learned their properties before adding herbals. I have not seen any good stats on our past use of drugs over the past century causing a decline in degenerative diseases (opposite has occurred, though). If the ancients were so smart, how come their societies had life expectancies far below what we have today, and horrendous infant mortality rates? You're seeing an increase in degenerative diseases for a variety of reasons; on of the main ones is that people now live long enough to get those diseases at all.
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