The hip online magazine Slate published an article that teaching physicians about new therapies and feeding them is a good for patients.
Doctors often to do not have time to read journal articles about new clinical studies or attend educational events (both promotional and accredited) about breakthroughs in treatments and devices because most doctors need to see patients every fifteen minutes just to keep their heads above water. That is why so many physicians use their lunch breaks, and sometimes dinners and weekends to meet with industry employees and attend programs where they can earn credits for continuing medical education (CME). Without the flexibility of such programs and employees that meet the needs and wants of doctors who require such updates and training to better treat their patients, the overall quality of care and effectiveness of treatment would surely decline.
Unfortunately, a “war against industry-sponsored medical education” has taken place over the past several years, making it harder for relationships between physicians and industry to collaborate and share their breakthroughs with doctors and their patients. The causalities from this war include “industry employees barred from giving talks during at least two important upcoming medical meetings, and oncologists from Vermont, Minnesota, and Massachusetts being forbidden from partaking in the snacks provided at corporate exhibit booths during a recent annual cancer society meeting.”
According to a recent article in Slate, “these developments come on the heels of a movement already well under way at medical centers around the country: ending the free lunch.” Proponents calling for an end to such events, ignore the impact industry funded education has by using doctors who are experts on a new medication to provide important updates on treating a particular disease. Moreover, the “mounting concern about ties between doctors and the pharmaceutical industry is not only unfortunate for anyone with a doctor, but it also doesn’t make any sense” to ax commercially supported medical education from hospitals and university medical centers around the country.
A perfect example of why industry supported education is essential can be clearly seen by the drug Remicade, which was first marketed for the treatment of Crohn’s disease. Although the FDA approved and labeled the drug for a long-term basis, “a long-term trial would have delayed getting it to patients in need—Remicade was a much better treatment than what was already available for Crohn’s.” So trial investigators went on to demonstrate the appropriate, off-label, use since “Remicade’s manufacturers couldn’t advertise the drug for long-term use.” As a result of their discovery, “gastroenterologists from the world’s top medical centers, who’d been part of Remicade’s development since its inception, traveled around the world, instructing doctors on how to use the drug.”
The impact of their work was significant because their experience developing Remicade and their “practical knowledge could never have been gleaned from a journal article or the package insert.” One of the reasons their instruction was so important is because “generally, the published reports of clinical trials present complicated statistical analyses about a drug’s likelihood to benefit patients,” and they “don’t teach how to use the drug.” Since industry funded CME does teach doctors how to use a particular drug, treatment or device, why then are such events being banned left and right?
With schools like the University of Pittsburgh, Mount Sinai School of Medicine, Stanford University School of Medicine, Johns Hopkins School of Medicine, and several other prominent institutions prohibiting industry-funded meals, how will key opinion leaders be able discuss the latest advances in treating a particular condition?
Part of the problem creating this concern is the belief from politicians and other federal overseers that “commercially supported CME leads to misuse of drugs.” In other words, critics believe a meal on the pharmaceutical company’s tab will lead a doctor to prescribe an expensive drug even if it is not the best treatment option.
But how else are doctors supposed to meet with experts, when “teaching sessions often take place during the lunch hour?” If doctors are not provided with paid lunch, it forces “hungry doctors to the cafeteria instead of the lecture hall,” which sometimes results in “lines so long that doctors missed the conference, and significantly decreased the attendance at some grand rounds conferences.”
As a result, when “industry-sponsored education is cauterized, it leaves a huge gap in care.” For example, “Stephen Hanauer, one of the clinical investigators who developed Remicade and who has been paid to speak to doctors about it, explained that as Remicade teaching sessions have been nixed, misuse of the drug has risen—and Hanauer thinks that the two phenomena are connected.” In particular, physicians who were “uneducated about its off-label use gave the drug as a single infusion, which led to resistance, leaving patients with very limited treatment options.” Another problem discovered was that “breaks between doses needed to be kept short, but many gastroenterologists did not have the chance to learn that, resulting in unnecessary sickness.”
This prohibition of commercial support “has also led many prominent medical centers to ban faculty from receiving significant amounts of industry dollars for teaching and consulting.” Such rules have been problematic because it is often “these professors who are the top experts in their field, the ones at the research helm.” These bans are also burdensome because “promotional talks given by drug reps—who are company employees, not doctors—are monitored by the FDA, and any discussion of off-label use is strictly prohibited.”
Similarly, bans on industry funded CME are also problematic because CME guidelines are strict, requiring programs to “present a balanced view of all treatment options for a given disease, and pharmaceutical companies may not influence the program.” While these regulations have ensured the integrity and quality of CME programs, “pharma has begun to pull away from funding CME programs, which means fewer free educational opportunities for doctors.” This is a problem for many physicians, especially those in rural and inner-city populations because “unsponsored, in-person CME programs can cost hundreds to thousands of dollars, which starts to pinch the wallet, even for doctors, who aren’t all loaded.”
Prohibiting industry funded CME also creates an undesirable situation for doctors to receive their necessary credits. For example, “without programs being brought to their door, most doctors must get their necessary credits in one fell swoop at their specialty’s annual conference, which offer CME sessions.” These events, often in a giant lecture hall, “are hardly the intimate atmosphere truly needed to learn about a new drug” because “presenting new drug data to an audience of thousands precludes the pertinent dialogue that’s possible in a smaller setting.” In addition, doctors who wait “until the annual meeting rolls around are not truly staying on top of the latest developments.”
Conclusion
Despite the criticism of industry funded CME and other events, evidence from a recent study showed the benefits such relationships bring. Specifically, the study found that academic researchers who were paid a modest honorarium to teach more than 14,000 doctors around the country about new treatment guidelines for high blood pressure resulted in adherence to those guidelines rising more than 8 percent where the most sessions took place. Conversely, in counties with the fewest such sessions, adherence decreased by 2 percent.
Studies like this clearly demonstrate that CME “helps move the latest medical advances out of the lab and into daily practice.” To maintain this flow of information to doctors however, we need commercially funded programs and CME because “the balanced nature of CME programs often leads to a very watered-down presentation of cutting-edge advances.” For instance, seminars, which present several speakers discussing multiple treatments for a disease don’t “hone in on the specifics of using one essential new tool, and the content, the size, and the impersonal nature of these talks don’t deliver the level of detail that doctors must know as they inject a new foreign substance into a living, breathing human.”
Instead, doctors need “small groups of people listening to a doctor talk about how to treat a disease.” Physicians need in-person, hands-on training, in which they hear an expert discuss the ins and outs of a new medication—what side effects to expect, how to manage them, how long to wait between infusions, when dose adjustments might be needed, etc.” And to carry out this kind of education, “there is no substitute for the commercial support required to run such programs that ensure the optimal treatment of patients.”
The most effective way to teach doctors about clinical trials and data is through hands-on learning that is commercially supported medical education so that the speakers can be paid and the session can be done in a way that works within doctors’ busy schedules. This kind of system, which the pharmaceutical industry has been taking for years, is what patients want because when people who know how to use the drug, tell doctors how to use a drug, it establishes a truly effective way to educate doctors.
If critics are so worried about the lunch being provided to doctors at such events, maybe they should ask patients whether they would rather have their doctor choose between lunch and a conference that keeps them up to date on how to treat a serious disease. Clearly then, “eliminating free lunch” will not solve “the entanglement caused by for-profit drug development” because “ousting commercial support will leave doctors not only hungry but also starved for knowledge.”