A recently published article in the American Surgeon 2009;75:395-400 titled “Industry Support of Graduate Medical Education in Surgery,” asserted that
“The American College of Surgeons recognizes two goals that are complementary: maximizing industry participation in continuing medical education programs and maintaining the autonomy and impartiality of surgeons and surgical organizations.”
This article, written by Don K. Nakayama, M.D., M.B.A. and Andrew P. Bozeman, M.D., from the Department of Surgery at Mercer University School of Medicine in Macon, Georgia, took survey results from directors in general surgery and surgical specialties to determine industry activities in surgical Graduate Medical Education (GME). Of particular importance from the study are the following results:
– One fourth believed their programs to be dependent on industry for their educational missions.
– 55% of the respondents noted that industry support of GME did not pose a problem for medical education in general, and 71% said it was not a problem regarding their specific programs. In fact, only 12% of the respondents surveyed believed that industry support of their medical education programs was a problem.
– Most respondents disagreed with the view that industry support of GME compromised such core values of medical education. 56% said that there was no compromise regarding evidence-based medicine; 63% said no compromise concerning cost effective care; 56% said no compromise of values in reference to professionalism; and 59% said their was no compromise to objectivity.
Interestingly, while these results came about, industry was already responding and adopting more stringent guidelines for their representatives including a prohibition on even small gifts like pens and notepads. Moreover, graduate programs also similarly acknowledged that industry-sponsorships of GME can be managed by the program director, who then can deny funding of any inappropriate activities. Yet the critics continue to play the broken record of “conflict of interest.”
In response, surgeons defend industry support overwhelmingly because it serves an essential purpose in the dissemination of approved drugs and devices into practice, and because advances in medicine often require industry to develop fundamental scientific discoveries into products that has value at the patient's bedside.
Surgeons further argue that “Profits are not antithetical to good medicine and patient care, and the prospect of making money is a powerful motive force toward science and product development.” In fact, as noted throughout the article
“Surgery has a rich history of productive relationships with industry. Examples are numerous and come easily to mind: the development of cardiac surgery; surgical stapling devices; the field of minimally invasive surgery, and endovascular catheter techniques and prostheses. Thus the development, testing, application and refinement of surgical devices involve industry and surgeons working closely together.”
Furthermore, TP Stossel, the most widely published advocate and defender of medical education and industry sponsored research argues that far from being misaligned, “the goals of industry and physicians coincide.” According to Stossel:
“ [both industry and physicians] want better patient care and beneficial, useable medical advances, [and] that while industry also has a profit motive this does not disqualify a partnership in bringing useable products to market. He believes that industry is the best mechanism to bring medical advances to the bedside, and marketing and advertising are the means through which this is done. He points out that the products themselves have weathered a long and costly process of testing, product development Food and Drug Administration approval and regulation that may take more than l0 years and has been estimated to cost $800 million.”
Consequently, these ideas are stressed even more because “to date there is no evidence that a hazardous relationship between industry and medical education exists.” In fact, “No surgical residency has been cited by the Residency Review Committee for deleterious relationships with industry having a negative effect on surgical education or care of patients.” As a result, the American College of Surgeons concluded there findings as follows:
“The present guidelines follow the principles of openness, quality of teaching, freedom from conflict of interest, and appropriate recognition for industry support. They are a reasonable reflection of the interdependent relationship between industry, surgeons, and surgical organizations, and presently they have no further need for modification.”
Other physicians agree with the findings from the American College of Surgeons and assert that rules and regulations are costly and only increase the cost of innovation, and increased regulation is forcing medical innovation offshore by making it too costly in the US. Professional associations and doctors also note that innovation needs commercialization to give value to an invention and as a result, physicians have to be in control as to how approved products are introduced and how they’re used.
Ask yourself this: When you need a pacemaker, and your surgeon is holding the scalpel over your anesthetized body, wouldn’t you prefer that your doctor worked with the industry and device making company that developed it?