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Published online 20 November 2007 | Nature | doi:10.1038/450464a
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Drug firms accused of biasing doctors' training
The uneasy link between industry and education.
Can the pharmaceutical industry be trusted to fund doctors' compulsory education without introducing bias? The issue is dividing Congress, academics and drugs companies. Now, preliminary data have emerged suggesting that industry-sponsored courses skew training material in favour of commercial interests.
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There is no surprise in this finding. As someone who worked for the Industry for over 35 years I can with personal experience say categorically that all the marketing hype with a psudo scientific image is, geeting the doctors to prescribe the drug. To this end gifts, luncheons, meetings, seminars and the continued medical education prgrammes,travel are funded. I am not wrong if I were to say that doctors are working for the industry even if they do not want to admit this.All this in a country like India with lax legal and ethical standards. ramki
The surprise with this article is that the author(s) seem to be surprised with what has been presented. Take an example: If a big German pharmaceutical company invites hundreds of doctors plus their wifes for a free long weekend in a classy hotel in - say - Barcelona, in order to give medical education - can there then be any doubt as to what purpose the event is intended ? IMHO this is nothing but a sophisticated way of bribery, and the sad thing about that mechanism is not that companies try to push their products, but that not too little a number of doctors appear to be bribable ... Martin Schmitt
It’s a miracle why Nature presents this fact as breaking news. Every physician knows that there is a lot of manipulation from the side of the pharmaceutical industry. But physicians don’t protest. At this moment, when the industry doesn’t sponsor their ‘educational’ activities, nobody will take over the sponsor role. What we need are pharmaceutical industries that invent really new medicines and are forbidden to do more than to advertise their products. Education and scientific meetings have to be organized and paid by everybody minus commercial parties. ... Jaap van der Stel ... Mental health institution ... Haarlem (The Netherlands)
Clearly these biases should be minimized, as their total elimination from academic life seems rather impossible. Leaders of the academic community (university presidents, deans, etc.) should not have any significant (preferably no) financial ties with drug firms, and their conflict of interest declarations should be disclosed. Andrzej Górski, Med Univ Warsaw/Polish Academy of Sciences
Why would these companies sponsor these events if they were not receiving something in return? Plain and simple. As with any profession you get a range of individuals in the medical and dental professions: those that trully enjoy their work, those that are in it for the money, those that are just not very good at what they do. It is time we each took responsibility for our own health. We need to empower the patient to use these individuals as advisees only. Too many people will just take the doctor/dentists word and not bother doing any research to see if they have been given the best advice. If people become more responsible for their own health the influence of biased professionals becomes less important.
Interestingly, the Breaking News from Nature is a commercially sponsored section. Is there any bias in it? Doctors taking sponsored CME activities should be in the best position to judge existing bias. Anedoctal evidence, like the one shown in the article, is by definition biased. There will always be bias.
Many U.S. doctors are aware of the commercial slant in CME courses and publications due to pharmaceutical company sponsors. But Most doctors (and consumers) have no idea that every prescription filled in a U.S. pharmacy is reported to an entity, administered by the American Medical Association, which in turn, for a fee, transmits the information to the pharmaceutical companies for use in promoting products, for example to design pseudo-scientific promotional CME courses and publications as discussed in this article. The AMA supposedly gives doctors a chance to “opt out†of prescription tracking by a click on AMA’s website, but this is a sham. Even if the doctor were to “opt outâ€, his/her prescribing data is still sent to the pharmaceutical companies. To “Opt out†merely means that the pharmaceutical companies are requested by the AMA, on a strictly voluntary basis, not to give that doctor’s prescription-tracking information to drug reps in the field. But the companies have the data available, thanks to the AMA, for all other marketing purposes
Echoing previous comments here, this is no big surprise, nor is it really news. However the article probably does not go far enough. It isn't simply that big Pharma is influencing clinical decision-making in ways that are both unethical and unwise, big Pharma is also influencing fundamental research in this country into a host of illnesses. Indeed one could argue that medical treatment in this country is becoming increasingly an extension of big technology and big Pharma as opposed to an extension of fundamental and of necessity independent science and scientific understanding. This is nowhere more starkly revealed than in my field, where any close examination of psychopharmacology and the generation of new drugs suggests that drug design is often market-driven as opposed to more science driven, with new agents produced that are essentially copy-cat imitations of existing blockbuster drugs. There certainly is some degree of progress and innovation, but it is clear that drug companies are more interested in grabbing market share with a "me-too" product as opposed to trying to take more risk and be innovative or move very far off the beaten path. And they are now spending significantly more on often misleading advertising than on research. More checks and balances are badly needed. In this country where the idealization of the free market as the solution to any and all problems is a virtual ideology, trumpeted repeatedly by those in power, we have not learned the first lesson about human political systems: power corrupts and absolute power corrupts absolutely. This insight informed the basic logic behind the checks and balances in our political system, and when those checks and balances fail in relationship to almost any issue, there are abuses of the kind we are now seeing in our medical system writ large. Drug companies have too much power, too much influence, and anyone who thinks that their primary motivation as corporate organizations is the welfare of the average citizen or person suffering with an illness needs a major reality check. And the average patient these days has almost no ability to discriminate between drug company claims and what scientific data really might say. The current situation simply cannot continue and a first step in its rectification would be the elimination of drug company advertising. Dr. Douglas F. Watt Harvard Medical School
When health, a private as well as a public domain, becomes mor & more of a commodity, attention need be given that business doesn't corrupt the integrity of health professionals, that socially prestigious link to patients. Otherwise, to protect the right of the patients, and that is every one of us in time series, ethics raises itself into medico-legal realm. This is on one hand not to empede the right of patients to recieve proper drug promptly, and upto date information on the drug prescribed; and on the other, respecting the right of the Medical Doctor to his own wise decision on what to prescribe, it is to deter inducement of health professionals by Pharmnaceuticals to prsecribe the 'drug of their Choices'. This is a complex ethical issue, and refers not only of specific Pharmas, but a general phenomenon that need be properly addressed, under say Guidlines, Acts, etc. on Consumer Medicine. And it need be put in Black & White for the society in general spans form patients to FDA, & the health professionals and pharmaceuticals, in particular, to adhere to. NO MORE SMOKE SCREENS. The suggestios of Professor D.Watt of Harvard University can also be part of these Acts or guidlines. Finally allow me to say, it's good the issue is at the floor of the Congress. The Australians are already twelve years ahead. Their experience can be of preliminary help. See ("General Guidlines for Health Professionals on Consumer Product Information". Common Wealth Department of Human Services. Canberra: Australian Government Publishing Service, 1995). Tesfaye Mengesha.
This kind of relationship has ever existed and the physicians are also very guilty in the process because many of them charge for something, be it money or any kind of sponsorship to prescribe the product. Now that more ethical companies are trying to implement the IPFMA code, I have seen myself doctors claiming why don't you take us and our families to a resort? On the other hand, when the doctors are not given some kind of compensation there are severe restrictions to the sales reps. And even worse, there are medical societies that charge an amount per year to allow the company to promote the product to the doctors. Isn't this a shame? If we want a completely unbiased CME, medical societies and physicians should work completely independently from pharmaceutical companies, but they charge a lot for the space in a congress, for a medical symposium etc. They are the first to sell the soul to the devil.
Efforts to bias others in Big Pharma? Why should anyone be shocked? When I can drive a highway, read a magazine, or view or listen to any form of mass media and NOT hear or see a slick advertisement for a drug, a doctor, a dentist, a clinic, or a hospital, then I can read an article such as this and be shocked. Health care professionals of every ilk have abondoned what were once accepted ethical restraints to become businessmen. Who's kidding who?
Actually, no surprise in such finding. Even much worse, it would not be an unforgiven offense to consider this industrial influence bias as a corruption in the medical field. In the sake of true science aiming to ameliorate our life- us humans, regardless of the state of any company's case or treasury, i would propose that no CME activity course should take palce without being organized by two or more competitor companies. Thank you.Samer
I am a medical doctor, and I agree with what many colleagues have already stated. Pharmaceutical companies play a major role in the education of doctors: through cleaner or dirties moves. I think it was very relevant that Nature published this paper, it is a pity that it was not published by a clinical journal! Anyway, I think we all agree that this represents a problem, so it would be important to find a solution. One could be to provide doctors with independent, publicly-funded information: a sort of Wiki-medicine!