Drug companies have become the biggest sponsors of continuing medical education courses in recent years, even at the nation's top medical schools, a development that critics say raises health-care costs, skews doctors' treatment decisions and allows the industry to skirt laws against advertising "off-label" uses for its products.
The trend accelerated after the government backed off a plan to limit commercial sponsorships in 2002 at the urging of the industry, Senate investigators said.
Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.
"Most of what doctors know about drugs comes from the industry, and that's not healthy," said Jerry Avorn, a Harvard Medical School professor and critic of the sponsorships. "Academic organizations lend their names to courses that are nothing more than infomercials."
But Scott Lassman, senior assistant general counsel at Pharmaceutical Research and Manufacturers of America, said industry funding of continuing medical education is a great way to educate physicians about the latest medical and scientific research.
The courses "are viewed as running independently of the pharmaceutical company," Lassman said. "The company may be providing the funding for it, but they are not directing the content."
He also defended the practice of discussing off-label uses for drugs -- uses not approved by the Food and Drug Administration -- in the courses. "A lot of times, the regulatory process lags behind the science," he said. "I think it's a benefit for physicians, as long as it's independent and as long as the scientific information is solid."
For doctors, though, drug company funding "makes it very difficult to know what research to believe," said J. Gregory Rosenthal, an Ohio retinal surgeon and a founder of Physicians for Clinical Responsibility, a group pushing for tighter controls on conflicts of interest in medicine. "Even at the [specialty] academy level, you can't go onto a Web site without being confronted by sponsorship logos."
Rosenthal will testify today in a hearing before the Senate Special Committee on Aging, which is looking into physician links with the drug industry. Sen. Herb Kohl (D-Wis.), the chairman, said the commercial sponsorship of courses creates a conflict of interest.
"It appears that everyone profits from this pervasive system of gifts and payments, except the consumer," Kohl said.
The hearing marks the second time this year that the Senate has examined the independence of industry-sponsored continuing education. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors' products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.
"There has to be a bright line between drug company spending on medical education and spending on marketing," Sen. Max Baucus (D-Mont.), the committee's chairman, said in remarks echoed by Charles E. Grassley of Iowa, the panel's top Republican.
Murray Kopelow, chief executive of the accrediting council, acknowledged that concerns over the drug industry's influence persist despite the advent of stricter oversight and ethical guidelines. "We've done a lot, but we believe we could do more in putting into place detection systems and monitoring systems in order to provide data to address those concerns," Kopelow said.
He said the drug industry does hold some sway over which topics are covered in the courses.
"Commercial interests fund educational activities that are consistent with their business," he said. "To that extent, the industry has some control over the topics that are taught. The title of the activity would not be in the hands of the commercial interest but would be in the hands of the accredited provider."
Last year's meeting of the American Psychiatric Association in Toronto, the field's biggest educational conference, reflects the extent of corporate sponsorships. In the meeting program, a voluntary listing of the financial ties to drug firms of the physicians who served as instructors covered 14 pages. Some instructors were sponsored by at least a dozen companies.
"Between a third and a half of medical providers have a relationship with industry," said Jerome P. Kassirer, a professor at Tufts University's School of Medicine and the author of a book about the financial links between doctors and drug companies. "These are promotional activities disguised as education."
In 2002, after identifying prescription drugs as the biggest factor in soaring federal health-care costs, the inspector general's office at the Department of Health and Human Services drafted tighter rules governing industry sponsorship of the courses, according to the Senate aging committee. Soon after, however, lawyers for the industry hand-delivered a 56-page memo objecting to the draft, and the guidelines the government eventually adopted closely matched the industry's voluntary code of ethics.
Some states have begun looking into the issue. In Pennsylvania, for example, Avorn, the Harvard professor, helped create RxFacts ( http:/
"I don't think we ever can or should prevent companies from making honest statements about their approved products," Avorn said. "But we need to give doctors a chance to hear from people who don't have products to sell."