In the latest effort to break up the often cozy relationship between doctors and the medical industry, the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses.
University officials voted to eliminate commercial financing, beginning next January, for postgraduate medical education, a practice that has come under increasing scrutiny from academics, medical associations, ethicists and lawmakers because of the potential to promote products over patient interests.
Dr. James O. Woolliscroft, dean of Michigan’s medical school, said leading faculty members “wanted education to be free from bias, to be based on the best evidence and a balanced view of the topic under discussion.”
While the financing in question amounts to as much as $1 million a year at Michigan, commercial payments for industry speakers and courses nationwide come to about $1 billion, nearly half the total expenditure for such courses.
The debate over whether the medical profession should develop an industry-free model of postgraduate education is a delicate one. A conference at Georgetown University on Friday, called “Prescription for Conflict,” will highlight the arguments on both sides through presentations by federal health officials, professors from leading medical schools, hospital executives and a Senate investigator.
Already this year, the debate has led to public squabbles as doctor groups have squared off over proposals for new restrictions on industry involvement in the courses known as Continuing Medical Education, or CME. The accrediting body for postgraduate medical education, for example, recently said it would no longer grant credit to doctors for attending medical meetings that feature industry employees presenting product research.
The decision was met with howls of dissent this month from some doctors, including the director of the National Institutes of Health and the president of the American Heart Association, who said it would unfairly cut physicians off from scientific knowledge.
On the other side of the argument, a leading medical ethicist asserted that the prohibition did not go far enough. Dr. Bernard Lo, lead author of a 2008 Institute of Medicine report on conflicts of interest, said private doctors and academic physicians who are paid to speak for drug companies should be barred from presenting educational material at accredited conferences. “Mouthpieces for their products,” he called them.
Private medical education companies, which receive money from drug makers to produce such courses, and some doctors who lead the courses, disagree that industry financing or speakers lead to bias. They say that company-financed programs provide a vital service, keeping doctors up to date on the latest and most effective treatments.
“We present what we think is the state-of-the-art of the management of the disease,” said Dr. Rafael Fonseca, deputy director of the Mayo Clinic Cancer Center in Scottsdale, Ariz., who gives 20 do 30 such courses a year, about half for universities and half for commercial medical-education companies. “The accusation that there is bias is not substantiated.”
Continuing medical education has become a big business in the United States, with more than 700 accredited providers. Total spending on such courses peaked at $2.5 billion in 2007, including a record $1.2 billion paid by companies, according to the Accreditation Council for Continuing Medical Education, a nonprofit regulatory group. It has declined slightly since then as the academy introduced new limits on industry involvement.
Thomas Sullivan, president of the Rockpointe Corporation, a medical education company that has received millions of dollars from drug companies, said the accreditation system is built with checks and balances to prevent industry influence over course selection or content. The courses themselves are intended to improve patient care, he said, not to promote a particular brand of treatment.
“We are really not trying to increase prescriptions,” said Mr. Sullivan, who writes a blog called Policy and Medicine. “It’s more about giving better care.”
But Dr. Michael Steinman, an associate professor of medicine at the San Francisco V.A. Medical Center who has studied the use of medical education as a marketing strategy, said that companies face an inherent conflict of interest. “The course providers have a subtle and probably unconscious incentive to put on courses that are favorable to industry because they know where their bread is buttered,” he said.
Even so, there is a paucity of rigorous science investigating the potential for commercial bias in continuing medical education courses.
Proponents of industry support for such courses point to a few studies in which the majority of doctors who attended the programs reported that they perceived the events to be free of commercial bias.
But Dr. Steinman, who conducted one of the studies, said that related research in social science demonstrates that people who receive gifts often feel obliged to return the favor. “Industry wouldn’t be paying billions of dollars to do this stuff if it didn’t benefit them,” he said.
The debate became heated at a meeting this month when some of the nation’s top doctors learned of the decision by the accrediting council to deny doctors educational credit if industry employees presented findings at the fall meeting of the American Heart Association.
Dr. Francis S. Collins, N.I.H director, criticized “the breathtaking sweep to squash something that is really important to us, which is the science that’s going on in the private sector.”
Dr. Clyde W. Yancy, president of the heart association, said he was mounting “a vigorous appeal” to the accrediting group. Although the policy might affect less than 1 percent of the total presentations, he said, it would ban significant and peer-reviewed scientific advances.
But Dr. Murray Kopelow, chief executive of the accrediting council, said the policy applies only to company employees who talk about products, not those who lecture on basic science or research methodology.
“Science done by industry can be reported by industry if it isn’t anywhere close to advertising, promotion or making a market for a product,” he said in an interview Wednesday.
The accreditation council first began insisting that courses should be “free of the control of a commercial interest” in 2004, but some medical organizations like the heart association have been protesting since a clarification last year that banned industry employees from talking about their business lines at accredited events.
As medical groups shun some industry money, doctors may face higher course fees, said Dr. Paul R. Lichter, director of the University of Michigan Kellogg Eye Center.
His department has not accepted industry financing for such courses for decades, he said. Next year, the entire medical school plans to eliminate commercial financing for the programs.
“This can be done,” Dr. Lichter said. “It’s what we are used to that makes it difficult to change.”