Drug-Company Influence on Medical Education in the USA

                        It begins on the first day of medical school and lasts through to retirement, and it is the only reliable "cradle to
                        grave" benefit that doctors can truly count on any more. Even in this era of medical-ledger watching world wide,
                        there is little evidence to expect it will ever end. In fact, it may even be growing.

                        It starts slowly and insidiously, like an addiction, and can end up influencing the very nature of medical
                        decision-making and practice. It first appears harmless enough: a textbook here, a penlight there, and
                        progresses to stethoscopes and black bags, until eventually come nights "on the town" at academic conventions
                        and all-expenses paid "educational symposia" in lovely locales. 

                        Attempts to influence the judgment of doctors by commercial interests serving the medical-industrial
                        complex are nothing if not thorough. Unfortunately, they seem to work. Studies have shown that prescribing
                        patterns are influenced by advertising and other marketing activities. If this were not the case, why would
                        industry spend hundreds of millions of dollars on promotion? 

                        Advertising sustains industry, and no industry, not even the medical one, can avoid its reach. So it is
                        not the fact of marketing that is in question here. It is the form in which it comes. Surely, no one would mistake
                        a pen with a corporate logo as anything but promotion. Nor would anyone suggest that a stuffed animal with a
                        brand-named drug stitched to its fur is of great medical value. But when the line between medical education and
                        advertising or marketing is blurred, there is a problem. 

                        A recent study completed by the US watchdog Public Citizen documents the relation between medical education
                        activities, the pharmaceutical industry, and medical education services suppliers (MESS), which are private
                        businesses that provide medical education. 

                        The study stems from survey data published in the December, 1999, issue of Medical Marketing & Media, an
                        industry periodical. MM & M surveyed 123 MESS about their 1998 and 1999 operations. 80 returned
                        questionnaires. In summary, the data suggest that supplying medical education can, in this form, be a very
                        lucrative exercise, whose most consistent client is the pharmaceutical industry. 

                        What is of most concern here is the fact that so much continuing medical education comes through the
                        filter of industry. To ensure the integrity, and the appearance of integrity, of the process of learning in
                        medicine, physicians should do more to pay for CME themselves, just as many other professionals have to do. 

                        Lancet September 2, 2000; 356: 781.