Separating continuing medical education from pharmaceutical marketing.

THE PHARMACEUTICAL INDUSTRY HAS GONE TOO FAR. IT IS ASsuming a role in continuing medical education (CME) that is inappropriate for an industry with a vested interest in selling prescription drugs. Worse, many medical educational institutions not only allow the industry’s encroachments but also welcome and even solicit pharmaceutical company participation in programs that should be the profession’s sole responsibility. As a result, CME is now so closely linked with the marketing of pharmaceuticals that its integrity and credibility are being questioned. The problem is not new, but it has recently grown to alarming proportions. Representatives of the pharmaceutical companies say their intention is simply to generate goodwill by helping the providers of CME with the costs of educational programs. That claim might be believable were financial assistance the total extent of their help and were the curriculum content and the educational event totally unaffected by the industry’s financial support. But that is not the case. The pharmaceutical industry provides a substantial proportion of the several billion dollars spent on CME annually and uses that support as a marketing tool. It could not invest such large sums without seeking more commercial benefit than mere goodwill and name recognition. The fiercely competitive nature of the prescription drug market plainly requires that companies tie their financial support to the promotion of their products, and that is what they do. Consider these pharmaceutical industry practices, now common in accredited CME programs, which have the effect of linking financial support of the programs to the marketing objectives of the companies that provide the funding. With the approval of the CME providers, pharmaceutical companies sometimes help organize and advertise the educational event; they may prepare teaching slides and curriculum materials, and they compile lists of possible speakers and indirectly pay them. They also may subsidize practitioners, medical students, residents, and fellows to attend. Attendees are often rewarded by the company with free meals and other amenities. In community hospitals, pharmaceutical companies often organize teaching conferences, and they provide free meals for attendees. At, or adjacent to, virtually all educational sessions subsidized by industry, sales representatives are allowed to display and promote the company’s products, particularly the products related to the topic of the program. The conflicts of interest and the likelihood of biased presentations inherent in such practices are obvious and hardly need elaboration. A recent review article on this subject included evidence showing that industry-supported educational activities are slanted in favor of the financial supporter’s products and that physicians attending such courses later prescribe these products more often than competing drugs. This should be no surprise to any experienced observer of industry-supported programs. Regardless of their technical pedagogic quality, most presentations are characterized by their friendly treatment of the company’s drug. The company’s mission is to sell its products, and it uses its participation in CME to further that end. Support for CME comes from the marketing budget in most companies, and that budget must produce sales. A spokesman for the industry’s trade association, the Pharmaceutical Research and Manufacturers of America, put it succinctly in a recent newspaper article about industry-supported CME: “Companies live through education,” he said. The detailing of individual physicians in practice, all-expenses-paid symposia for physicians in posh resorts, and mass advertising to the profession and the public all serve the same purpose. Like CME, they are called education by the pharmaceutical industry, but they are all intended to promote sales. The true purpose of pharmaceutical support of CME is perhaps most clearly revealed by the growing new industry called Medical Education and Communication Companies (MECC). These for-profit companies, now numbering more than 100, put together educational programs to be presented in hospital grand rounds and in freestanding CME presentations, and they prepare various other teaching materials for physicians. The MECCs are paid mainly by pharmaceutical companies, and they supply their educational pro-