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Published: Thursday, 6/21/2007

Harmful side effect

A BY-PRODUCT of recent revelations about heavily marketed drugs that turned out to have lethal or deleterious side-effects is a dirty little secret of the medical profession: half of doctors' important continuing medical education is apparently financed by pharmaceutical companies.

Most states require doctors to spend a minimum number of hours each year updating their medical education to retain their license to practice. So far, so good. Given the rapid advances in the field, it would be criminal in terms of patients' well-being for a doctor not to keep up to date on medical progress.

Such continuing medical education traditionally was organized and presented by universities and medical associations. But Daniel Carlat, a professor at Tufts Medical School in Boston, outlined this week in a New York Times oped piece how that is changing.

The trend is toward such education now being financed by pharmaceutical companies. He wrote that, while the drug industry paid for one-third of medical continuing education courses a decade ago, now it's half - some $1.12 billion worth.

In principle, it is possible that a lecture on the treatment of diabetes paid for by GlaxoSmithKline would have mentioned that the company's highly promoted drug, Avandia, had been shown in some tests to damage patients' hearts, just as Merck might have come clean on the side-effects of Vioxx and Eli Lilly on Zyprexa.

Professor Carlat said, however, that the drug firms have taken the trouble to duck the Accreditation Council for Continuing Medical Education's strictures against paying doctors to promote particular drugs by working instead through what are called medical education communications companies.

The pharmaceuticals pay the companies, which then organize the courses, which doctors are then paid to lead. In espionage and less polite business terms that's called using a cut-out, in search of a semblance of deniability.

What happens now - doctors receiving "education" which can be thinly masked advertising for particular drugs, paid for by the makers of those drugs - is definitely not in the best interests of the patients. Nor should the practice be ethically acceptable to the doctors.

We agree with Professor Carlat that the organization and presentation of continuing medical education should be returned to universities and medical associations. Medical centers, hospitals, and physician practices should assure the public that such a policy governs the doctors working under their umbrella.

Pharmaceuticals' financing of such teaching should be strictly excluded, and any continuing education financed even partly by a drug company should not count for credit when a decision is made to renew a doctor's license.

Recent experience with an increasing list of drugs, companies, and doctors has made it clear that patients badly need such protection from the companies and the doctors. State legislatures should provide that protection through changes in the law. It would have been nice if respect of professional ethics on the part of doctors had provided it, but that has not turned out to be the case.

Instead, money talked and patients' health paid the price.

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