Drug companies become the primary educator for America’s doctors

WOW!! I do not understand why people cannot understand that the
concept: He/she who pays the piper calls the tune? This is not a difficult
concept to understand, however, as we look at every industry in the U. S. we
find Conflict of Interests abound and no one, except for Mr. Carlat,
realizes that this is a serious problem. If we cannot rely on the unbiased
reporting from our Federal Government on issues that influence and affect
the quality of health care services we receive – what type of Democracy do
we really have?? Tom Garvey

http://www.nytimes.com/2007/06/13/opinion/13carlat.html?ex=1182398400&en=c3a
1e9464cace80d&ei=5070&emc=eta1

Diagnosis: Conflict of Interest

NY Times Op-Ed Contributor

By DANIEL CARLAT
Published: June 13, 2007
Boston

THE revelation that the diabetes drug Avandia can potentially cause heart
disease is the latest in a string of pharmaceutical disappointments. Vioxx
was pulled from the market in 2004 because it doubled the risks for heart
attacks and strokes. Eli Lilly recently paid $750 million to settle lawsuits
alleging that Zyprexa causes diabetes. Many have criticized the Food and
Drug Administration as being too lax about monitoring drug safety.

While those criticisms have merit, there is another culprit: the
transformation of continuing medical education into an enterprise for drug
marketing. The chore of teaching doctors how to practice medicine has been
handed to the pharmaceutical industry. As a result, dangerous side effects
are rarely on the curriculum.

Most states require that doctors obtain a minimum number of credit hours of
continuing medical education each year to maintain their medical licenses.
Not so long ago, most of these courses were produced and paid for by
universities and medical associations. But this has changed drastically over
the past decade.

According to the most recent data available from the national organization
in charge of accrediting the courses, drug-industry financing of continuing
medical education has nearly quadrupled since 1998, from $302 million to
$1.12 billion. Half of all continuing medical education courses in the
United States are now paid for by drug companies, up from a third a decade
ago. Because pharmaceutical companies now set much of the agenda for what
doctors learn about drugs, crucial information about potential drug dangers
is played down, to the detriment of patient care.

For example, GlaxoSmithKline footed the bill for dozens of educational
courses intended to emphasize the benefits of Avandia over other drugs. An
influential Internet-based educational program paid for by the company
focused on specific studies that highlighted Avandia’s advantages without
discussing one of the drug’s most worrisome side effects, increased levels
of the lipids implicated in heart disease.

Avandia’s chief competitor, a drug from Takeda Pharmaceuticals called Actos,
improves lipid levels but was hardly mentioned. When GlaxoSmithKline’s
program did cite Actos, it did so tepidly. The information in the course was
presented by noted diabetes academics paid by GlaxoSmithKline and other drug
companies.

GlaxoSmithKline is not the only offender. The major organizations in
diabetes education, like the National Diabetes Education Initiative, offer
dozens of continuing medical education courses on diabetes that are free to
doctors and paid for by drug companies. Predictably, each course focuses on
the advantages of the sponsor’s product and minimizes discussion of
dangerous side effects.

Education that doubles as advertising for drug companies occurs in all
branches of medicine. Merck promoted Vioxx for arthritis by using programs
for continuing medical education, which helped contribute to the more than
100 million prescriptions of the drug before it was pulled from the market.

According to Dr. David Graham, a safety researcher for the Food and Drug
Administration, Vioxx was responsible for up to 140,000 cases of serious
heart disease from 1999 until 2004, when it was withdrawn. But the potential
cardiac dangers of Vioxx were played down in the courses paid for by Merck.
In one instance, the company canceled lectures it had sponsored by a
Stanford researcher who had mentioned, in talks to doctors, the cardiac
risks from taking Vioxx.

Drug companies should never have been allowed to become the primary educator
for America’s doctors. The Accreditation Council for Continuing Medical
Education, a nonprofit organization composed of the major medical
associations, establishes the rules that govern continuing medical
education. According to the guidelines, companies are forbidden from
directly paying doctors who teach continuing medical education courses.

But the standards have a loophole that allows drug companies to circumvent
the regulations. They hire for-profit “medical education communication
companies” to organize the courses. These companies receive millions of
dollars from drug companies to create course work and to pay doctors to
deliver the content. Sometimes, they pay doctors to give lectures to other
doctors. Other times, prominent doctors are paid to be listed as the authors
of journal articles that are written by ghost writers, a practice that was
extensively documented in court records from a lawsuit against Pfizer.

Either way, the content is rarely developed by the identified experts.
Instead, it is developed by the undisclosed communication company, which is
paid by the sponsoring pharmaceutical company.

Essentially, this is a new twist on that well-known instrument of
corruption, money laundering. Drug companies don’t directly pay doctors to
teach courses. Instead, they pay someone else to cut the checks. Similarly,
the drug companies don’t explicitly tell doctors to say good things about
their products. Instead, they hire a company to write good things about
their products and to pay doctors to deliver the messages.

These shenanigans were recently spotlighted by Senator Max Baucus, Democrat
of Montana, and Senator Charles Grassley, Republican of Iowa, of the Senate
Finance Committee. In April, their committee released a report, two years in
the making, concluding that drug companies have used educational grants
unethically as a way of marketing their products.

In response, the guidelines regarding commercial support for continuing
medical education are being reviewed. The solution could hardly be simpler:
any continuing medical education that is paid for by the drug industry
should not be accredited. Drug companies could still pay for any educational
event, article or pamphlet they choose, but their courses and materials
would no longer bear the imprimatur and implied credibility of
accreditation.

Doctors, in turn, would be encouraged to seek medical education from sources
that are not financed by drug companies. A renewed commitment to unbiased
education would allow doctors to learn about drug risks sooner. This would
be good for doctors, and even better for their patients.

Daniel Carlat, a professor at Tufts Medical School, is the editor in chief
of The Carlat Psychiatry Report.