Hold the Hors d'Oeuvres

In an interview she said that overt sales pitches are anathema in CME courses because they alienate doctors.

Instead "there are messages that help the drug companies, like 'Osteoporosis is a killer disease and affects one quarter of all women,' '' she said. "The message is that this is real and it affects your patients." Sometimes, she added, CME courses precede the launch of a drug that may be no more effective than those on the market. Older, cheaper generic alternatives or non-drug treatments receive short shrift.

Obstetrician-gynecologist Anthony Scialli said that examples of inappropriate prescribing related to CME courses abound.

"Take oral contraceptives," said Scialli, a reproductive toxicologist who teaches at Georgetown. "Over the years they have increased in number, but there haven't really been any major advances since the 1970s. The newer ones are more expensive. Why do doctors prescribe them? Because of promotion and educational activities" funded by the manufacturers.

The same thing occurred with hormone therapy for post-menopausal women, he said, which for decades was touted as an essential way to stave off heart disease and dementia -- until federally funded research showed the pills were linked to the very conditions they were supposed to prevent.

While industry sponsorship of CME courses is widespread, it is not universal.

At the small, 270-student medical school of East Carolina University in Greenville, N.C., associate dean Stephen Willis has managed to keep industry influence to a minimum. Less than 10 percent of the school's $600,000 CME budget comes from pharmaceutical companies or medical device manufacturers, he said.

"I'm ethically opposed to commercial support of CMEs," said Willis, a family physician. "I just deal with too many people who have to choose between heat in the wintertime or paying for drugs.

"Most taxpayers have no idea that they could pay less for their drugs if the pharmaceutical companies took the couple of billion dollars they spent subsidizing CME and used it to reduce the cost of drugs," he added.

Willis said he thinks doctors should pay for CME courses themselves.

So does Fugh-Berman, who notes that they are a tax-deductible expense.

"The education of physicians should be funded by physicians, not by a third party whose profits are directly related to prescribing behavior," she wrote. "Weaning CME from the industry breast is like striving to meet our energy needs without oil -- tough but necessary." ·

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