In response to increasing criticism over its sponsorship of physician-education courses (and the suggestion of undue influence on doctors prescriptions and procedures), the drug maker Pfizer announced in July 2008 that it would no longer pay marketing communications companies to arrange continuing medical education (CME) courses, which doctors must take to maintain their licenses. Pfizer said it would support medical education only when it was put on by hospitals and professional medical associations. Zimmer Holdings, a medical device manufacturer that manufactures hip, knee, and elbow implants, suspended funding of all CME activity. The company said it will restrict the way it funds courses in the future by identifying an independent third party, such as a professional society, to organize educational programs.
“We understand that even the appearance of conflicts in CME is damaging, and we are determined to take actions that are in the best interests of patients and physicians,” Dr. Joseph M. Feczko, Pfizer’s chief medical officer, said in a press release.
Industry support for CME has quadrupled since 1988, to $1.2 billion a year, according to the Accreditation Council for Continuing Medical Education (ACCME), an organization in Chicago that approves CME providers. More than half of that is funneled to marketers, with the rest going to hospitals, medical associations, and other nonprofit entities.
As industry money for continuing education proliferates, so do worries that many of the courses have become at least partly aimed at promoting products. The industry and its outside marketers say they ensure that the courses remain free of commercial influence. But some medical experts argue that when employees of communications firms are beholden to pharmaceutical and device companies, they will produce CME courses that are slanted in favor of their sponsors, even if they don’t realize what they are doing. “There’s not only a perception of bias, there’s a reality,” says Dave Davis, a vice president of Association of America Medical Colleges.
In January 2010, Pfizer appeared to modify its 2008 position by announcing a $3 million grant to Stanford University to create continuing medical education courses that the company claims will come with “no conditions, and the company will not be involved in developing the curriculum.” However, critics have argued that the curriculum will most likely focus on at least two areas in which Pfizer has major product lines: smoking cessation and heart disease.
#1) Where is the conflict of interest in this CME relationship?
#2) Do you think doctors are likely to be influenced by such promotional tactics? Why or why not?
#3) If the pharmaceutical company is paying for the event, shouldn’t it have the right to promote its products at the event? Why or why not?
#4) Pfizer stated in 2008 that it would only support medical education put on by hospitals and professional medical associations. How can it then justify the Stanford grant?
#5) Has Pfizer simply replaced one conflict of interest with another? Why or why not?
#6) Propose an alternative approach to ensure that CME is provided without a conflict of interest.