Virtual Mentor. February 2007, Volume 9, Number 2: 109-112.
Corporate Sponsorship of Continuing Medical Education
Guidelines are offered for deciding when it is appropriate for a physician to accept corporate-sponsored continuing medical education.
Rosamond Rhodes, PhD, and James D. Capozzi, MD
Everybody knows that advertising works. Corporations that pay for it know that it is effective and that their investment in product promotion is well spent. Advertising even works effectively on physicians; recent studies have irrefutably demonstrated that advertising has a direct impact on physician prescribing patterns [1-4]. Nevertheless, most physicians, even those who are aware of the data, consider themselves to be immune to the phenomenon, and, because the effects are invisible to each affected individual, they continue to deny that they are or can be moved. Physicians may, therefore, be dismissive of concerns about conflict of interest that are raised by the gifts and the attention of drug and medical appliance manufacturers. The obvious problem with accepting manufacturers' largesse is that physicians' critical assessment of products may be dulled and their judgment skewed away from a profession-directed focus on the benefit of patients. That influence, coupled with the pervasive denial of the phenomenon, creates one arm of this dilemma.
The other arm relates to the need for medical education in the face of current financial arrangements that leave institutions of academic medicine unable to fund important training programs. Current U.S. tax policy allows corporations to accumulate the wherewithal to fund product promotion and enables them to write off product promotion costs as business expenses. The only restrictions on product promotion business activities are minimal fair-trade, truth-in-advertising standards. At the same time, current U.S. policies for funding medical education are woefully inadequate for meeting the need to keep physicians up to date with rapidly advancing pharmaceutical and technological developments. Physicians cannot do the best for their patients when they are not well-informed about relevant scientific advances, the latest developments in drugs, surgical techniques and medical devices or when they do not have the opportunity to develop and refine their skills in using them. Continuing medical education is an essential feature of physicians' professional responsibility. Patients can miss opportunities for better outcomes or can suffer harm because of the lack of physician education.
While a change in our tax structure could, in the future, go far toward resolving the dilemma of either forgoing crucial physician education or funding it through means that can generate conflicts of interest, in the here and now choices have to be made. The American Medical Association Council on Ethical and Judicial Affairs (CEJA)  and the American Academy of Orthopaedic Surgeons' (AAOS) Committee on Ethics  should be applauded for their efforts to outline a path between the Scylla and Charybdis of compromising options. As philosopher, political theorist and historian of ideas Isaiah Berlin noted,
A caveat that should be gleaned from Berlin's insight is that no plan or guideline for navigating such situations can avoid transgressing ethical borders. Every resolution reflects the competing hazards and advantages. No concession can claim ethical purity; that is not in the nature of compromise. Guidelines can only identify some of the key considerations and provide reasons that publicly explain their importance.
When comparing the competing goals of promoting medical education and avoiding conflict of interest, the likelihood and significance of the opportunities lost by forgoing what industry offers have to be assessed and compared to the likelihood and significance of undue influence on physicians' judgment. In sum, the question that must be considered is whether the package being offered is worth the costs. We consider the following criteria to be critical:
These considerations suggest at least one guideline that appears on neither the AMA's list nor that of the AAOS. Before accepting any industry-sponsored education or incentive, a physician should make a sincere effort to form an independent evaluation of the product. He or she should review the professional literature, examine a sample and consult colleagues. Only when a product appears to warrant further exploration and the information can only be obtained through a corporate-sponsored venue should a physician open the door to industry.
Clearly, the relationship between physicians and industry is controversial, the relative importance of the factors that have to be taken into account is uncertain, and thoughtful people can draw lines in different places. This conclusion should not be surprising precisely because judgment is critical to the analysis and because dilemmas require us to prioritize competing and important values that reasonable people may rank differently.
Rosamond Rhodes, PhD, is a professor of medical education and director of bioethics education at Mount Sinai School of Medicine and professor of philosophy at The Graduate Center, City University of New York.
James D. Capozzi, MD, is associate clinical professor of orthopedics at Mount Sinai School of Medicine in New York City and chair of the American Academy of Orthopedic Surgeons Committee on Ethics. His practice subspecialties are hip and knee replacement surgery and fractures in the elderly, and he writes on medical ethics.
Related in VM
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
© 2007 American Medical Association. All Rights Reserved.