The Guardian 12 October, 2005

Ongoing education for doctors:

"Owned and controlled by big pharmaceutical corporations"

Dr Con Costa

Ongoing education is a vital part of being a doctor — very little in medicine being still the same as when most of us left university. If you don’t keep up to date both you and your patients are in big trouble.

But recent criticisms of the post-graduate education system, Contin­uing Professional Development (CPD), is somewhat misplaced. Some doctors may be rorting the system — but most take it very seriously.

The real problem is that the ongoing medical education system has been taken over by the big pharmaceutical companies, as has our medical science.

The interaction between the big pharmaceuticals and the doctors has intensified over the last 20 years and is driven by the enormous profits made by the pharmaceutical industry.

It is said that the drug companies spend on average $30,000 per year on each Australian doctor — about $1 billion per year on doctor interaction and "education". By way of contrast the Federal Government spends a paltry $15 million, and is said to save at least three times this amount in the better prescribing by doctors that results.

The rules state that drug company gifts to doctors cannot be valued at more than $10. The result is many drug company "educational" dinners, weekends away at a luxury resort and the endless stream of drug company sales representatives, known as drug reps, in doctors’ surgeries offering the latest array of plastic gadgetry.

Post-graduate education and medical research is now so heavily funded by pharmaceutical companies as to have created an environment where nobody can retain objectivity and most medical research has inherent bias.

By leaving the doctors’ ongoing education system to the drug companies it is government, more than the doctors, that ends up with the "free lunch". And the drug companies seem increasingly determined to get value for their dollars.

There is enormous pressure on the "independent medical speaker" at drug company-sponsored educational dinners to mention products by name, and speakers often oblige. The talks are usually on subjects chosen by the drug companies to highlight their products. Thus doctors are given endless "educationals" on medications that lower cholesterol in the blood (called lipid-lowering medicines), drugs for impotence or for "diseases" that are for most people part of the natural ageing process — osteoporosis, dementia etc.

To make sure the doctors keep coming back for more, such talks are often held at the more salubrious restaurants around town or even luxury resorts on weekends away.

At yet another educational on lipid-lowering drugs, I went along mainly to ask the cardiologist about the benefits of fish oil and other supplements in managing my patients. He admitted that he used the supplements in his own cardiology practice and that there was good scientific evidence they work — but had not mentioned them, or other alternatives to statins (a class of lipid-lowering drug), "because he had only been asked to speak about the drug company’s product".

At some of these educational dinners the drug reps can almost outnumber the doctors. Often the drug reps cannot resist a promo for their drug product before or after the medical speaker — after all they are paying the bill and they have a captive audience.

Inevitably one drug rep will be allocated to each table — maybe more if a "loose cannon" is suspected?

In such a situation it is difficult for doctors to have a free and open discussion with their peers.

Some doctors are cowered by the syndrome — don’t speak up for fear of being labelled a "trouble maker". Others merely keep quiet out of politeness and in order not to offend when you have supped and drank (sometimes copiously) at their host’s table.

If a doctor has a differing point of view, or even an independent question, most of us now wait in silence until after the talk has concluded and hope to corner the speaker — often one of our trusted specialist colleagues — and furtively ask our questions in private.

Getting medical scientific knowledge, or ongoing post-graduate education, untainted by commerce is becoming increasingly difficult — even if doctors had the time to do the research.

Manufacturers of drugs and medical products fund 70 per cent of current clinical research. Studies show that findings published by researchers with company connections are almost four times more likely to favour industry products than research done independently.

An article published in the Journal of the American Medical Association (2003;289:454-65) reviewed studies on the extent, impact and management of financial conflicts of interest in biomedical research. The conclusion was that financial relationships amongst industry, scientific investigators, and academic institutions are widespread.

Another study published in the British Medical Journal in May 2003 concluded "systematic bias favours products which are made by the company funding the research". Such widespread bias has serious implications.

It is known that 30 per cent of the conclusions of the Cochrane Review — considered the most authoritative source of medical evidence — contain errors where conclusions are not supported by the evidence under review. This is now being addressed but there is compounding of the errors due to commercial bias — a bias always in favour of the drug companies.

This is because drug companies do not reveal all of their data — especially data which is negative for their product, or against using the drug. This then affects the systematic review, which is only as good as the studies that are published.

It may not be such a bad thing that doctors are "falling asleep" during their post-graduate ongoing education sessions — or that doctors are getting CPD points [necessary to continue in practice under Medicare — Ed] for attending educational sessions on wealth creation rather than on patient management. At least these sessions contain less bias, the information is not selective and you can ask any question you like of the speaker — and in full view of your colleagues and the drug reps.

Con Costa is a Sydney GP and qualified physician,
and Vice-President of the Doctors’ Reform Society.

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