Conflict Alleged in Drug Firms' Education Role

By Elizabeth Williamson and Christopher Lee
Washington Post Staff Writers
Wednesday, June 27, 2007

Drug companies have become the biggest sponsors of continuing medical education courses in recent years, even at the nation's top medical schools, a development that critics say raises health-care costs, skews doctors' treatment decisions and allows the industry to skirt laws against advertising "off-label" uses for its products.

The trend accelerated after the government backed off a plan to limit commercial sponsorships in 2002 at the urging of the industry, Senate investigators said.

Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.

"Most of what doctors know about drugs comes from the industry, and that's not healthy," said Jerry Avorn, a Harvard Medical School professor and critic of the sponsorships. "Academic organizations lend their names to courses that are nothing more than infomercials."

But Scott Lassman, senior assistant general counsel at Pharmaceutical Research and Manufacturers of America, said industry funding of continuing medical education is a great way to educate physicians about the latest medical and scientific research.

The courses "are viewed as running independently of the pharmaceutical company," Lassman said. "The company may be providing the funding for it, but they are not directing the content."

He also defended the practice of discussing off-label uses for drugs -- uses not approved by the Food and Drug Administration -- in the courses. "A lot of times, the regulatory process lags behind the science," he said. "I think it's a benefit for physicians, as long as it's independent and as long as the scientific information is solid."

For doctors, though, drug company funding "makes it very difficult to know what research to believe," said J. Gregory Rosenthal, an Ohio retinal surgeon and a founder of Physicians for Clinical Responsibility, a group pushing for tighter controls on conflicts of interest in medicine. "Even at the [specialty] academy level, you can't go onto a Web site without being confronted by sponsorship logos."

Rosenthal will testify today in a hearing before the Senate Special Committee on Aging, which is looking into physician links with the drug industry. Sen. Herb Kohl (D-Wis.), the chairman, said the commercial sponsorship of courses creates a conflict of interest.

"It appears that everyone profits from this pervasive system of gifts and payments, except the consumer," Kohl said.

The hearing marks the second time this year that the Senate has examined the independence of industry-sponsored continuing education. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors' products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.

"There has to be a bright line between drug company spending on medical education and spending on marketing," Sen. Max Baucus (D-Mont.), the committee's chairman, said in remarks echoed by Charles E. Grassley of Iowa, the panel's top Republican.

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