Controversies in Cardiovascular Medicine. Is There a Role for Industry-Sponsored Education in Cardiology? Funding for Medical Education: Maintaining a Healthy Separation From Industry
Jerry Avorn, MD; Niteesh K. Choudhry, MD, PhD
From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass.
This paper can be accessed at: http://circ.ahajournals.org/cgi/content/full/121/20/2228#R5-869636
The most direct form of industry-supported education is through funding for continuing medical education (CME) activities. Support from pharmaceutical and medical device manufacturers for CME, which has quadrupled over the past decade, accounts for more than half of the $2.4 billion that is spent annually on CME.
Manufacturer-sponsored CME is associated with increases in prescription rates of the sponsor’s medication, perhaps because of the added attention paid to it during these sessions. In one study, the positive effects of the sponsor’s drug were mentioned 2.5 to 3 times more often than those of competitor’s drugs. Interactions with pharmaceutical representatives increase the likelihood that a physician requests to add the company’s drug to hospital formularies by more than 300%, and the receipt of honoraria to discuss a company’s new drug is associated with even larger effects on formulary requests. Interactions with detailers have been linked to more frequent prescribing of the marketed drug, as well as prescribing that is more expensive and less evidence-based.
There are other equally important but less visible forms of industry-funded education. "Speakers’ bureaus," in which prominent physicians are paid to lecture about a company’s products, constitute another common form of industry involvement in teaching. Manufacturers may exert substantial influence over the content of these lectures and frequently provide the slides to be used; some physicians earn more than $50 000 per year from these talks alone. Other "key opinion leaders" (known in industry marketing language as KOLs) can earn up to $10 000 from a corporate sponsor for chairing a single educational symposium.
The sales representative, or "detailer," is a major source of drug information for many physicians. This is especially true for new products, for which there may be little or no information available in the medical literature. On average, cardiologists meet with pharmaceutical sales representatives 9 times per month.
Unfortunately, many of these salespeople may have limited scientific training and are paid on a commission basis, depending on how much of their company’s products are prescribed by the clinicians they target. There is also growing evidence of companies’ use of such communication to persuade physicians to prescribe products without a given Food and Drug Administration indication and, more importantly, without adequate evidence of efficacy or safety. Several of the nation’s largest drug companies have in recent years paid enormous sums in legal settlements mandated by state attorneys general for such off-label marketing of Neurontin (gabapentin, Pfizer: $430 million settlement), olanzapine (Zyprexa, Lilly: $1.3 billion settlement), and valdecoxib (Bextra, Pfizer: $2.3 billion settlement). The author concludes: "We believe that the wealthiest nation on earth should be able to provide neutral, evidence-based educational messages about medications to physicians and patients without having to accept the trade-off that industrial sponsorship of such education inevitably requires...Because the clinical stakes for our patients are so high, and because the healthcare system of the coming decade will have to expend its constrained resources in the most cost-effective manner, cardiology and the rest of medicine will need to move beyond having vendors provide or pay for the education of its practitioners. The transition will be challenging for a time, but our patients, the healthcare system, and we as professionals will be better off for it".
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