Who educates doctors?

         You may be surprised to learn that continuing medical education for doctors is not provided exclusively--or even primarily--by the medical profession or the university system.  The New York Times for June 13, 2007, reported that a sea-change has occured in continuing medical education over the past decade.  In 1998, drug-industry financing of continuing medical education amounted to 300 million dollars.  By 2007, the drug manufacturing industry was contributing 1.12 billion dollars and paying for half of all continuing medical education in the United States.

         The risk associated with this situation can be demonstrated by Vioxx, the pain-killer that was responsible for an estimated 140,000 cases of serious heart disease between 1999 and 2004, according to Dr. David Graham, safety researcher for the FDA.  When drug manufacturers sponsor physician education, they have a natural profit-incentive and cultural bias toward minimizing the potential health risk associated with a particular drug, and toward promoting drug use in general.  Education about drug use and risks tends to be entirely one-sided and unbalanced.

          To counter this common-sense problem, the organization that accredits and certifies continuing medical education forbids drug manufacturers from paying physicians who teach continuing medical education courses.  To circumvent this prohibition, the drug companies hire for-profit "medical education communication companies" to organize CME courses.  These companies launder drug company dollars that compensate physician lecturers and writers--who then present data as though it were originating from a neutral source.  A recent lawsuit against Pfizer documented that physicians were even compensated for appending their name to medical journal articles ghost-written by the industry.  In case you think that this risk is only theoretical, you should realize that Republican Charles Grassley of Iowa and Democrat Max Baucus of Montana headed a U.S. Senate Committee that recently concluded--after a two-year study--that drug companies do in fact use this educational process unethically as a marketing device.