A report released last month by the Senate Finance Committee revealed a dirty little secret about pharmaceutical marketing. Drug companies are bribing doctors to prescribe certain medications. But pharmaceutical companies are not exactly slipping physicians envelopes stuffed with cash – their approach is far more subtle and effective than that. Instead, drug manufactures are footing the bill for Continuing Medical Education. In addition to the coursework, these programs often provide those attending with lavish meals and myriad “freebies” that promote the sponsoring company’s products. As a result, my physicians end up prescribing medications based not on what is best for their patient, but on the biased information they receive at drug company-sponsored classes and lectures.
Last year, pharmaceutical companies spent over $1 billion on CME courses. That’s a lot of money, so it should come as no real surprise that many of these courses are thinly disguised marketing ploys But according to the Finance Committee’s report, the effects go much deeper. During its investigation, the Finance Committee found that drug companies were using CMEs to influence clinical practice guidelines and Medicaid formularies. That finding was particularly disturbing to the Committees Chairman, Max Baucus (D-Mont.). “American taxpayers spend billions of dollars every year on drug treatments for Medicaid and Medicare patients, and those dollars must be spent wisely,” said Baucus. “Medical Education funded by drug companies has to be real education, not a soft-sell designed to sway treatment decisions.”
But all too often, these CME programs are exactly that. Take the case of Avandia, a diabetes drug that was recently linked to serious heart problems. According to a June 13th New York Times editorial, GlaxoSmithKline, the maker of Avandia, paid for dozens of CME courses. While the stated purpose of these courses was to inform physicians about the newest developments in diabetes treatment, they were really advertisements for Avandia. These programs trumpeted the advantages of the drug, but never mentioned its many side effects. Other diabetes medications that had fewer side effects were cited, but with very little enthusiasm.
It shouldn’t be this way. The Accreditation Council for Continuing Medical Education (ACCME) has rules spelling out who is allowed to pay for CME courses, and drug companies are not allowed to directly fund such programs. But “directly” is the operative word here. There is nothing in the rules that prohibits the pharmaceutical manufacturers from paying a third party to design and promote courses. And that’s exactly what they do. The drug company pays a so-called “medical education communication consultant” millions to develop coursework. And of course, the class materials always end up portraying the sponsoring company’s products in a good light.
While the Senate Committee did not issue any recommendations for dealing with the problem of medical education funding, it did say it planned to follow-up on its findings with the drug companies, ACCME and the FDA. But these organizations have proven largely ineffective in policing this abuse. Many patient advocates have called on states to quite accepting these drug-company courses as CME credits. If this were done, they contend that doctors would have no choice but to look for more objective sources to fulfill their education requirements.
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