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News July 31, 2008, 5:00PM EST

Teaching Doctors—or Selling to Them?

(page 2 of 2)

That generated a flurry of encouraging messages from other physicians saying they, too, are fed up with what they see as the commercial taint of many CME courses.

In an interview, Carlat praises Pfizer's decision to pull funding from medical communications firms. "It sends out a message that there's a level of distrust about the way [the marketing firms] operate," he says.

A spokeswoman for J&J's Janssen unit says in an e-mail that the company has no influence over its CME providers' selection of course content or faculty. "The accredited provider is solely responsible," she says.

Medscape, a unit of publicly held WebMD Health (WBMD), says it has been refining its CME courses to comply with new standards instituted by the accreditation group, ACCME. "We have a rigorous editorial process in place to make sure the content we develop is independent," says Dr. Steven Zatz, Medscape's executive vice-president of professional services. He adds that in polls, 99% of Medscape users say they perceive no bias in the company's online courses. Zatz says the J&J-funded course was recently updated, although he won't specify the changes. When Carlat signed on again in late July, he says he found the paliperidone question had not been revised.

The ACCME recently sent letters to the 84 biggest recipients of commercial funding for CME, asking for details about how they manage industry relationships. In the past, the ACCME says it lacked the staff and funding to police these companies. But that's changing, says the association's CEO, Murray Kopelow. "We're ramping up, so we can know more about what's going on in this field." Continuing education providers fund Kopelow's group.

A FUZZY LINE

Part of the potential problem with commercially funded CME is that many courses are designed by the same companies that produce more outwardly promotional events, such as fancy restaurant dinners where doctors are paid to talk up new drugs to peers.

To quell conflicts concerns, the Philadelphia-based marketer Vox Medica moved its CME activities into a wholly owned subsidiary in 2007, even going so far as to banish the unit's eight employees to a separate wing of its building. When hiring physicians to lead the courses, Vox Medica's medical education chief, Stephen Lewis, says he is much more inclined now to steer away from faculty members who have been paid by pharmaceutical or device manufacturers.

A lack of transparency fuels some concerns about medical communications companies. Doctors who are paid to teach—regardless of whether they do so at explicitly promotional events or CME courses—are supposed to disclose any industry funding. Yet in medical journals, where such disclosures are most prevalent, authors rarely list their financial ties to companies such as Vox Medica or Medscape.

Vox Medica's chief executive, Donald Phillips, believes concerns about alleged conflicts of interest could be alleviated if doctors were required to reveal payments from marketing firms such as his. "Companies and doctors shouldn't be using us as a veil," he says.

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Impartial Education

Dr. Paul C. Hebert, editor-in-chief of the Canadian Medical Association Journal, argues that potential conflicts of interest in continuing medical education could be avoided if all courses were run by an independent organization. He suggested in a March editorial that industry funding of CME need not be banned; funds should be funneled to a central institute, which would manage CME to avoid pro-industry bias.

Limited Payments

In June, the Association of American Medical Colleges (aamc.org) issued guidelines on how the nation's teaching hospitals should interact with the life-sciences industry. Working with a task force that included retired Merck CEO Roy Vagelos, the organization recommended that faculty members turn down offers to serve as paid speakers for pharmaceutical or medical device companies. If physicians feel they ought to make such presentations—for example, to demonstrate a device—their hospitals should allow them to take payment only at "fair market value," the AAMC said.

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