Has Big Pharma gone too far? Former New England Journal of Medicine editor slams industry-sponsored

Shelley Wood

April 18, 2001

Wed, 18 Apr 2001 16:00:00

Chicago, IL - A former editor-in-chief of the New England Journal of Medicine has accused the pharmaceutical industry of "going too far" with its participation in continuing medical education (CME), but industry representatives counter that their contributions are vital and obligatory. This time the standoff takes place on the pages of the April 18, 2001 issue of JAMA.

The dueling views appear less than 1 week after Chest ran three articles debating industry participation at medical meetings. This latest dispute, comprising a short op-ed piece by New England Journal of Medicine editor-emeritus, Dr Arnold Relman (Brigham and Women's Hospital, Boston, MA), and a response from Alan F Holmer (President, Pharmaceutical Research and Manufacturers of America, Washington, DC), zeros in on the issue of industry-sponsored educational seminars.,

"CME is now so closely linked with the marketing of pharmaceuticals that its integrity and credibility are being questioned," warns Relman.

Relman is careful to distinguish between industry collaborations in education and those in research, noting that the pharmaceutical industry plays an important and compulsory role in research initiatives. By contrast, education, says Relman, is none of their business.

Obligation or nonsense?

Holmer, invited to respond on behalf of the pharmaceutical industry, takes the opposing view. He claims industry plays a "valuable role" in education and has a responsibility to physicians and their patients to become involved in CME.

"The pharmaceutical industry and the medical profession are obligated to do all they can to ensure that physicians, the key prescribers of prescription medicines in the healthcare system, are thoroughly informed about the latest medical developments," Holmer rejoins.


It's nonsense. It's fatuous.


Responding to Holmer's argument in an interview with heart wire , Relman rejects Holmer's stance outright. "It's nonsense. It's fatuous. What it says is that the professional investigators and medical scientists in the teaching institutions, who have done much of the research anyway, are not qualified to teach students about this material. And that's absurd."

Accreditation: heal thyself

Relman concedes that the fault does not really lie with industry representatives who cannot be blamed for attempting to market their products. Relman is more concerned with what he calls the "permissive and ambiguous" standards held by the Accreditation Council on Continuing Medical Education (ACCME).

"Although the pharmaceutical industry is seriously misguided in becoming so deeply involved in CME, more fault lies with the professional providers of the accredited CME programs that have allowed and even encouraged this involvement to grow," says Relman. To heart wire , Relman elaborated: "You have to be born yesterday to think that this is an arm's-length relationship."


You have to be born yesterday to think that this is an arm's-length relationship.


Relman claims that the ACCME, the body that regulates CME, bases its decisions on recommendations made by an outdated task force, comprised of "a substantial number" of people who actually have overt ties to industry. "The task force is hopelessly and inevitably biased," Relman told heart wire . "There's no possibility that you're going to get an unbiased independent view of CME from that task force, no matter what they say, and the ACCME is supposed to represent professional organizations that serve the public interest. They ought to step back, take a deep breath, and say how do we reclaim the full responsibility of professional education for the profession itself?"

Costs and value

Holmer makes the point that, as with research, industry provides CME with financial support for educational initiatives, filling the gaps left by dwindling private and government funding.

Relman, however, shrugs off the funding issue, asserting, "Most professional institutions capable of providing good CME can afford to provide it at cost, without subsidies from pharmaceutical business." Likewise, "practicing physicians can afford to pay for their continuing medical education...but then may value it more, demand higher quality, and learn more from it."

Relman calls on the ACCME to "rethink its function" and be more discerning about who should be receiving accreditation to offer CME. He told heart wire , "I think it's time for the professional medical educational organizations that are supposed to be educating students and residents and providing CME to doctors in practice to step up and assume their responsibility."


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