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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 suggests 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.
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