piecing together bits of truth about gov't and corporate influence

Sunday, October 25, 2009

Dr. Kate Scannell: Educating doctors -- When Pharma writes the script

In Sunday's Oakland Tribune, aka , Bay Area News Group-East Bay.
I'm surprised, why did the editor(s) approve this?
It's just the tip of the iceberg. I suspect that Pharma writes the script for and appoints the gatekeepers in the FDA, CDC, WHO, etc., including the ACCME and CME.


LAST YEAR, pharmaceutical companies paid about half of the cost of educating America's doctors who sought to maintain their certification. That's a whopping $1 billion of marketing — er, "education" — meant to influence how doctors in practice should treat their patients.

If the notion of drug companies teaching physicians disturbs you, you may want to ask your own doctor about "Zisain'tsobad" — an "anti-disturbiosis" pill I learned about at the last industry-sponsored educational seminar I attended. However, if you are not concerned about this troubling arrangement, you may wish to ask your doctor whether you have TMO (Too Much Obliviousness) — because you might be helped with "GetReal-II", a second-generation attitude-adjuster available in pharmacies now.

Personally, I am waiting for the discovery of a pill that will eradicate pharmaceutical companies from medical education. I've not heard this being discussed at any of the seminars, but I remain hopeful (thanks to my once-a-day DreamOnz!).

It is hard — but not impossible — to avoid drug-company sponsored "medical education" when it is so prevalent and regularly camouflaged. As a doctor, you often feel like a captive audience; most states require you to take a certain number of courses each year in continuing medical education, or "CME," to maintain your accreditation.
A group called the "Accreditation Council for Continuing Medical Education" (ACCME) is charged with monitoring the quality and integrity of CME courses provided to doctors. That's a formidable task when half of the CME funding is provided by a powerful industry with a tremendous stake in convincing physicians to prescribe their products. The task is more ominous when you consider that more than 100,000 CME activities involving more than 750,000 hours of instruction were provided to physicians in 2008 alone.
One certainly hopes that the ACCME has hired more than the four staffers it had assigned in the prior year to monitor CME activities, according to ACCME watchdog Daniel Carlat.
A few more recruits seem necessary if the accrediting agency expects to stand up to the 90,000 drug representatives the pharmaceutical industry employs and the overall $30 billion-$50 billion it annually spends on drug promotion and marketing.
Concerns about the drug industry teaching physicians ought to be central in the current debates over health care reform and cost containment. Ridding physician education of pharmaceutical marketing messages would help to limit biased, overly exuberant, and costly prescribing practices. Testimony offered in recent hearings at a Senate Committee on Aging claimed that the government could save $900 billion over the next decade if industry-financed CME was eliminated.
Cost to the medical profession's reputation — hard to capture in dollar signs — might also be recouped if patients could better trustdoctors to uphold standards that do not arise from the drug industry's marketing departments.
However, the elimination of industry-financed medical education is going to require many doctors to suffer a painful withdrawal process. The truth is that the medical profession would not be so addicted to drug money if we physicians had just said "no" from the beginning of our unhealthy liaison with pharma.
Many of us doctors have knowingly attended industry-funded CME conferences, feasting on the shrimp or pizza that drug companies use to lure us into their sponsored talks. We have collaborated with pharmaceutical companies — for a fee — to promote their research and publications.
Most disturbingly, many of us have accepted drug money for the explicit purpose of insider influence over our own colleagues, delivering drug-marketing messages in the guise of industry-sponsored CME.
For example, a Boston Globe editorial this month revealed that one drug company alone — Eli Lilly & Co. — paid at least 60 doctors in Massachusetts more than $580,000 in total during the first three months of the year to deliver speeches about its drugs to otherdoctors. The company provided the content for those speeches. Furthermore, it was projected that fully one in six doctors might be taking speakers' fees from drug companies.
Last week, the head of the ACCME said he was prepared to take stronger action to curb commercial bias in medical education. However, I see no convincing evidence that his group will be any more effective than it has been on the watch so far.
Some people feel that the solution will come only by legislative action that aims to curtail industry influence. For example, some states — like Massachusetts, Maine and Vermont — have passed so-called "sunshine laws" to set limits on industry payments to physicians or to require public disclosure of those payments. And perhaps they are right.
But I would prefer to see another solution. Maybe I've taken too much of my DreamOnz, but I am holding out hope that my profession will take the lead and break the cycle of drug money addiction that has all of us in its hold.
Kate Scannell is a Bay Area physician and syndicated columnist.

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