Pharmaceutical companies and continuing medical education: the issue is not new

Popular belief is that the controversy over drug company influence on physician education started in the 1980s. According to this commentary in the August 20 edition of JAMA the issue has been around much longer. Initial concerns surfaced in the 1950s and the debate has not changed substantially. While the deluge of new drugs and promotions is larger now, physicians have better and more readily available sources of information to keep track of new drugs and examine promotions critically.

See if this sounds familiar:

Following studies in the 1950s documenting that physicians consistently rated pharmaceutical sales representatives as the most important source in learning about new drugs, the role of commercial sources in physician education became a subject of research to market researchers, sociologists, psychologists, and the medical profession. These studies challenged the image of physicians as autonomous professionals insulated from the influence of marketing, and cataloged the nonrational bases of many prescribing decisions.

So the substance of the debate has not changed at all even if the conditions have. For all the talk about the profession’s “dependency” on drug companies today, in a very real sense doctors were more dependent in earlier decades. Doctors had a few journals and textbooks (usually out of date) and little else. There was no Internet and there were no EBM tools. Drug companies came to the rescue with multiple “throwaway” journals and monographs full of advertisements.

Absent the dates this paragraph could easily describe today’s climate:

As evidence of the influence of pharmaceutical marketing over prescribing decisions mounted by the late 1950s, a cadre of academically based clinical investigators and educators began to clamor for corrective action. In a widely cited 1957 address, Harry Dowling (an active member of the American Medical Association's [AMA’s] Council on Drugs) argued that the increasing influence of pharmaceutical promotion on bewildered physicians prescribing worthless or redundant drugs constituted a moral crisis and a failure of the profession to uphold its duties of self-regulation of knowledge. Dowling's critique was joined by other prominent figures in the fields of infectious disease (who linked the problem of antibiotic misuse to exuberant pharmaceutical promotion) and clinical pharmacology (who sought to distinguish rational from irrational use of
prescription drugs).

Fast forward to the 1960s when the payer source became a hot topic for debate (italics mine):

In 1963, a JAMA editorial declared of CME: "The principal source of financial support must come from within the medical profession. Financing often determines control, and control must remain in the hands of the profession." However, investing in CME required funds that could not be borne out by tuition fees alone, and the pharmaceutical industry soon proved a willing partner in providing the ever-increasing budget for high-technology communications solutions to information transfer in CME.

In other words over 40 years ago the role of drug companies in the funding of CME was considered important. That concern has gotten plenty of attention in this blog, where I have warned repeatedly against “throwing the baby out with the bathwater.”

Another recurring theme is the idea that the profession should “take control” of CME. While that’s often a call to end industry funding the idea could cut both ways. Loud voices favoring an end to industry funding are in the minority. Surveys suggest that most doctors in the rank-and-file do not want this support to go away. If the profession, with representation of all its members, really takes control of the issue some level of industry support will continue.

Daniel Carlat’s take this morning is here.