Industry Support of Medical Education

ArticleinJAMA The Journal of the American Medical Association 300(9):1071-3 · October 2008with6 Reads
DOI: 10.1001/jama.300.9.1071 · Source: PubMed
Should professional medical institutions (medical schools and teaching hospitals) and their staff accept support from industry for their educational programs? This long-standing debate has become more urgent in recent years, particularly with respect to accredited continuing medical education (CME). With a budget now approaching $3 billion, CME is more than half supported by industry.1 Currently, most industry support is distributed through medical education and communication companies (MECCs) that act as agents for the pharmaceutical manufacturers. Many more billions of drug industry largesse is expended on personal gifts, favors, and payments to the physicians on the staff of teaching institutions.2
    • "There is little systematic research on the impact of financial support for continuing education for physicians, although there are some reports of potential bias in favor of the pharmaceutical industry131415 Remedies to control conflict of interest range from individual discretion to collective regulations including legal action [16,17]. In the past decade, guidelines and recommendations were developed by an expert panel, professional societies, accrediting bodies, the pharmaceutical industry associations and the government in the United States1819202122. In Japan, physicians working for public hospitals are prohibited from accepting kickbacks [23]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. Methods and Findings A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. Conclusions Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.
    Full-text · Article · Sep 2014
    • "I n an ever changing world of medicine, continuing medical education (CME) programmes are considered an inescapable requirement. More than half of all professional conferences and CMEs are organised with the help of sponsorship from pharmaceutical companies and device manufacturers [1]. With increasing sponsorship, the venue and character of these conferences has significantly transformed [2]. "
    Full-text · Article · Jan 2011
    • "All of these aspects undermine the credibility of guidelines and permit personal bias to determine the care of patients --the very problem that evidence-based guidelines are intended to avoid. Indeed, these deficiencies may undermine the ethical foundation of medicine, which requires 'physicians to put the needs of patients ahead of personal gain, to deal with patients honestly, competently , and compassionately, and to avoid conflicts of interest that could undermine public trust in the altruism of medicine' [24]. The integrity of medicine, and, ultimately, its value to society depends upon recognizing and safeguarding this ethical foundation. "
    [Show abstract] [Hide abstract] ABSTRACT: Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.
    Full-text · Article · Jun 2010
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