It’s time to examine pharma funding of doctors’ education
The pharmaceutical industry seeks to increase sales by influencing how doctors prescribe medications. To help achieve this goal, it sponsors the education and ongoing training of doctors.
The College of Family Physicians of Canada – the organization responsible for accrediting continuing medical education and certifying all family doctors in Canada – has expressed concern about industry’s influence over doctor education. In 2010, the College commissioned a taskforce to determine how much the sponsorship money was affecting the content of the educational programs it accredits. The College stated it did this with the intent of maintaining the “trust of its members, their patients and the Canadian public.”
According to an article in the College’s journal by Dr. Francine Lemire, chief executive officer at the College of Family Physicians of Canada, the College-appointed taskforce presented its findings and recommendations at the November 2013 board meeting, but did not make them public. Lemire also reported that at this meeting, the board asked the College to do a cost-benefit analysis of ending industry funding. Despite being asked to present this analysis at the November 2014 board meeting, the College has not yet released its findings.
In June 2015, we sent a request to Dr. Lemire to release the cost-benefit analysis on ceasing industry support. She declined our request, stating that the College was still examining the financial impact of dissociation and expressing concern that the loss of industry money would have a significant effect on College activities.
Why is pharmaceutical sponsorship a problem and what can be done about it?
All Canadians should be concerned about pharmaceutical sponsorship of physician education. Sponsorship biases the content of educational programs. In particular, it leads to a narrower range of topics. For example, industry-sponsored educational programs tend to emphasize medications and ignore other treatments, such as diet, exercise and physiotherapy. Additionally, the programs favour the pharmaceutical sponsor’s products.
This bias, in turn, has a harmful effect on physician prescribing. Studies show that physicians who interact more frequently with the pharmaceutical industry have poorer prescribing habits: they are less likely to follow independent guidelines and more likely to prescribe expensive medications.
The implications of industry influence over doctor prescribing are clear in the current opioid crisis. Purdue, a pharmaceutical company, funded tens of thousands of pain-related educational events that touted the benefits of OxyContin (a potent opioid painkiller) and downplayed its harms. As a result, sales of OxyContin and other potent opioids skyrocketed. As sales increased, so did harms from opioid use. Deaths from opioid overdoses now outnumber deaths from car accidents in Ontario.
Medical organizations need to have the courage to take a different approach. Several large American medical institutions have successfully halted all industry funding. Sloan Kettering Cancer Center reports that it was able to cut industry funding by holding conferences at the hospital instead of expensive off-site venues, using in-house faculty as presenters instead of flying in and housing outside experts, cutting back on its budget for advertising CME events in mail-outs and ads in journals, no longer providing meals at conferences, and increasing fees for those attending CME events by 10% to 20%.
Patients have the right to know about industry sponsorship of doctors’ education
The College’s worry about the financial impact of the loss of industry funds does not release it from its ethical obligation to be transparent. As members of the College of Family Physicians in Canada, we call on all final reports on pharmaceutical funding of education and the cost-benefit analysis on ending funding to be available to College members and other Canadian medical societies.
More importantly, the information should be available to the members of the public. Canadians are affected by industry influence whenever their doctor writes a prescription. Patients pay the costs when doctors prescribe a newer, more expensive medication instead of an older, equally effective medication with a well-established safety profile. Canadians have a right to know how much industry is influencing Canadian family doctors’ prescribing habits and how this influence can be stopped.
Sheryl Spithoff is a family physician and addiction medicine physician at Women’s College Hospital and a lecturer at the University of Toronto. Carol Kitai is a family physician and medical director of the Family Practice Health Centre at Women’s College Hospital. Joel Lexchin teaches health policy at York University and works as an emergency physician at the University Health Network.