Conflict Alleged in Drug Firms' Education Role

Murray Kopelow, chief executive of the accrediting council, acknowledged that concerns over the drug industry's influence persist despite the advent of stricter oversight and ethical guidelines. "We've done a lot, but we believe we could do more in putting into place detection systems and monitoring systems in order to provide data to address those concerns," Kopelow said.

He said the drug industry does hold some sway over which topics are covered in the courses.

"Commercial interests fund educational activities that are consistent with their business," he said. "To that extent, the industry has some control over the topics that are taught. The title of the activity would not be in the hands of the commercial interest but would be in the hands of the accredited provider."

Last year's meeting of the American Psychiatric Association in Toronto, the field's biggest educational conference, reflects the extent of corporate sponsorships. In the meeting program, a voluntary listing of the financial ties to drug firms of the physicians who served as instructors covered 14 pages. Some instructors were sponsored by at least a dozen companies.

"Between a third and a half of medical providers have a relationship with industry," said Jerome P. Kassirer, a professor at Tufts University's School of Medicine and the author of a book about the financial links between doctors and drug companies. "These are promotional activities disguised as education."

In 2002, after identifying prescription drugs as the biggest factor in soaring federal health-care costs, the inspector general's office at the Department of Health and Human Services drafted tighter rules governing industry sponsorship of the courses, according to the Senate aging committee. Soon after, however, lawyers for the industry hand-delivered a 56-page memo objecting to the draft, and the guidelines the government eventually adopted closely matched the industry's voluntary code of ethics.

Some states have begun looking into the issue. In Pennsylvania, for example, Avorn, the Harvard professor, helped create RxFacts ( http://www.rxfacts.org), a two-year-old program that provides physicians with evidence-based, noncommercial prescription information.

"I don't think we ever can or should prevent companies from making honest statements about their approved products," Avorn said. "But we need to give doctors a chance to hear from people who don't have products to sell."