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BMJ: Investigation Reveals "Invisible Influence" of Sponsors in Medical Education

LONDON, Feb. 21, 2008-Amid global calls to end drug companies' direct sponsorship of doctors' education, this week's BMJ reports on an investigation in Australia which reveals sponsor involvement in the education of thousands of general practitioners.

This weekend, a programme by the Australian Broadcasting Corporation will show that it is not uncommon for drug company sponsors to suggest speakers at sessions that are assumed by the thousands of general practitioners who attend them to be totally independent.

Drug industry representatives have confirmed that similar practices take place in the United Kingdom, where roughly half of all education for doctors is sponsored by drug companies, writes Ray Moynihan, honorary lecturer at the University of Newcastle in Australia.

He describes how leaked documents and emails from a range of sources show drug company sponsors having input into the selection of some speakers at seminars held in recent years, despite the fact that these have been aggressively sold to general practitioners in brochures claiming that "all content is independent of industry influence."

The drug industry's representative body Medicines Australia has confirmed that the practice of inviting input from sponsors into the selection of speakers is by no means uncommon, while the view from the drug industry is that allowing sponsors to suggest speakers does not compromise the independence of medical education, as the educational providers have ultimate control over who speaks.

However, research for the investigation in Australia reveals several examples where sponsors' suggestions were embraced by the company providing supposedly independent education, writes Moynihan.

Industry representatives in Australia and the UK strongly argue that, in the interests of transparency, doctors attending educational sessions should be fully and explicitly informed if sponsors have suggested speakers for these sessions.

Such a degree of disclosure could radically change perceptions of the content of accredited education, says Moynihan, which many doctors believe to be independent of sponsor influence.

The evidence, such as it is, tentatively indicates that the prescribing habits of doctors may be affected by attending sponsored educational events, albeit only in the short term.

A recent paper by Harvard Professor David Blumenthal, an internationally recognised authority on relationships between doctors and drug companies, and colleagues called on US academic medical centres to end the direct drug company sponsorship of continuing medical education events. They suggested the creation of a blind trust to fund education at an institution level. Others have called for medical education to be funded by the taxpayer through competitive grants.

Oversight of these educational events is currently a self-regulatory affair, and institutions seem uninterested in guaranteeing independence, argues Moynihan.

Perhaps the recent revelations from Australia, and confirmation from the industry itself that it is "not unusual" for sponsors to suggest speakers, will sharpen the lines of debate about how to achieve more independent education or at least greater transparency, he concludes.

Ray Moynihan, Conjoint Lecturer, Faculty of Health, University of Newcastle, Callaghan, Australia, and Visiting Editor, BMJ

Posted: February 2008