Self-interest taints GP learning curve
ONGOING education is a vital part of
being a doctor – very little in medicine being still the same as
when most of us left university. If you don't keep up to date
both you and your patients are in big trouble.
The real problem is that the ongoing medical education system has been taken over by the big pharmaceutical companies, as has our medical science.
The interaction between big pharma and the doctors has intensified over the last 20 years and is driven by the enormous profits made by the pharmaceutical industry. It is said that the drug companies spend on average $30,000 per year on each Australian doctor – about $1 billion per year on doctor interaction and "education". By way of contrast the federal Government spends a paltry $15 million, and is said to save at least three times this amount in the better prescribing by doctors that results.
By leaving the doctors' ongoing education system to the drug companies it is government, more than the doctors, that ends up with the "free lunch".
The rules state that drug company gifts to doctors can't be valued at more than $10. The result is, in addition to the many drug company "educational" dinners, the less frequent weekends away at a luxury resort and the endless stream of drug company sales representatives, known as drug reps, in our surgeries, doctors are being enticed with the latest array of plastic gadgetry from China.
The problem is of course much bigger than the drug reps. Postgraduate education and medical research is now so heavily funded by pharmaceutical companies as to have created an environment where nobody can retain objectivity and most medical research has inherent bias.
There is enormous pressure on the "independent medical speaker" at drug company-sponsored educational dinners to mention products by name, and speakers often oblige. The talks are often on subjects chosen by the drug companies that highlight their products. Thus doctors are given endless "educationals" on medications that lower cholesterol in the blood (called lipid-lowering medicines), drugs for impotence, and for newly manufactured diseases that are for most people part of the natural ageing process – such as osteoporosis or dementia.
To make sure the doctors keep coming back for more such talks are often held at more salubrious restaurants and locations – such as luxury resorts on weekends away.
At yet another educational on lipid-lowering drugs, I went along mainly to ask the cardiologist about the benefits of fish oil and other supplements in managing my patients. He admitted that he used the supplements in his own cardiology practice but had not mentioned them, or other alternatives to statins (a class of lipid-lowering drug), "because he had only been asked to speak about the drug company's product".
At some of these educational dinners the drug reps can almost outnumber the doctors. Sometimes the drug reps cannot resist a promo of their drug product before and after – especially if their state manager is in attendance and they have a captive audience.
In such a situation it is difficult for doctors to have a free and open discussion. If a doctor has a differing point of view, or even an independent question, most of us now wait in silence until after the talk has concluded and hope to corner the speaker – often one of our trusted specialist colleagues – and furtively ask our questions in private.
Getting medical scientific knowledge or education untainted by commerce is becoming increasingly difficult – even if doctors had the time to do the research. Manufacturers of drugs and medical products fund 70 per cent of current clinical research. Studies show that findings published by researchers with company connections are almost four times more likely to favour industry products than research done independently.
An article published in Journal of the American Medical Association (2003;289:454-65) reviewed studies on the extent, impact and management of financial conflicts of interest in biomedical research. The conclusion was that financial relationships amongst industry, scientific investigators, and academic institutions are widespread.
Another study published in the British Medical Journal in May 2003 concluded "systematic bias favours products which are made by the company funding the research". Such widespread bias has serious implications.
It is known that 30 per cent of the conclusions of the Cochrane Review – considered the most authoritative source of medical evidence – contain errors where conclusions are not supported by the evidence under review. This is now being addressed but there is compounding of the errors due to commercial bias – a bias always in favour of the drug companies. This is because drug companies do not reveal all of their data – especially data which is negative for their product, or against using the drug. This then affects the systematic review, which is only as good as the studies that are published. It may not be such a bad thing that doctors are falling asleep during their post-graduate ongoing education sessions – or that doctors are preferring educational sessions on wealth creation rather than patient management. At least these sessions contain less bias, the information is less selective and you can ask any question you like of the speaker – and in full view of your colleagues and the drug reps.
Con Costa is a Sydney GP and qualified physician, and vice-president of the Doctors' Reform Society.
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