The Beat Goes On: Arguing About Pharma's Influence on Med Ed

However, the fact that a 50-year argument on the subject goes on merely indicates this: There's still no tangible evidence that pharma's potential influence on continuing medical education (CME) alters physician competence or patient outcomes—for better or worse.

In the closing of their JAMA commentary, Podolsky and Greene quote advertising executive Pierre Garai from 1963: "We know what the doctors are today. What will they be tomorrow?" This originally rhetorical question cannot be answered, of course, for today's physicians; but it can be addressed for physicians who were practicing during the early 1960s.

Therefore we can ask, what untoward healthcare event has occurred during the last 45 years as a result of pharma's influence on CME?

The only event that comes to mind (to which Podolosky and Greene also allude) is the overuse or misuse of antibiotics, ostensibly as a result of pharma marketing injected into industry-funded CME. However, a search of the medical literature does not support this contention (although an exhaustive search, for the purposes of this blog post, cannot be guaranteed).

On the other hand, a survey of Georgia pediatricians, discussed in a 1999* issue of Pediatrics, indicates that the decision to prescribe antibiotics for children is influenced by 1) diagnostic uncertainty (ie, Is the illness viral or bacterial?); 2) sociocultural and economic pressures (eg, consideration for time-strapped working parents); 3) fears of malpractice litigation; and 4) parental expectations. While the surveyed physicians may have been reluctant to admit to the influence of pharma-funded CME on their prescribing behavior, it seems unlikely that this potential influence would supersede the practice considerations cited by the surveyed physicians.

So the debate will continue, until there is compelling evidence that pharma's influence on CME—influence that has clearly been moderated during the last several years—has caused some undeniably beneficial or untoward healthcare outcome. 

* Arguably the height of pharma's influence on CME, before the institution of stricter firewalls between pharma marketing and CME.

Photo of the pop duo Sonny & Cher, who charted with the 1967 hit "The Beat Goes On," from Wikipedia.

Addendum: Some may cite the exuberant use of off-label fen-phen in the 1990s as an example of the adverse influence of pharma-funded CME. However, the fen-phen mess doesn't seem to be easily distilled to a single factor. Nevertheless, I am certainly receptive to any evidence that Wyeth funded CME activities in which the drug combination and supportive studies were discussed.