Classes won’t take drug firms’ money
Last week, Dr. Martin Samuels received a dinner invitation in the mail: He was invited to The Palm steakhouse to hear a Columbia University specialist discuss novel treatments for multiple sclerosis — and to earn continuing medical education credits.
But Samuels will not be attending. The class, he said, is not education, but subtle marketing by Teva Neuroscience, a pharmaceutical maker that sells a leading multiple sclerosis drug and, according to the fine print, is paying for the evening.
It is just this type of program that led Samuels, a Harvard Medical School neurologist, to start a new company that he says will provide continuing medical education to doctors across the country — without funding from the pharmaceutical industry.
“Doctors have lost confidence in [continuing medical education] and the public has lost confidence,’’ said Samuels, who sees patients at Brigham and Women’s Hospital, where he heads the neurology division. “The feeling is that everything is tainted. We simply must have a new way of doing this.’’ The company’s formation will be announced today.
The venture is the latest development in an escalating national debate over the system for educating physicians. States require physicians to take continuing education courses to retain their medical licenses, but doctors often pay little or nothing for the instruction because many of the companies that offer it are partly funded by makers of drugs and medical devices. Samuels himself worked part time for such a company until last year, when he said he decided that commercial support created an unacceptable conflict.
Critics say the reliance on industry funding allows drug and device companies to influence what is taught, potentially misleading physicians about the best treatments for patients and pushing up spending on prescription drugs. They note that many other professionals pay for their own continuing education.
Dr. Murray Kopelow, executive director of the organization that accredits medical education providers, said that the criticism is overblown, and that the vast majority of providers comply with his group’s rules, which forbid industry funders from influencing the content of courses or who presents them.
Teva, the funder of the Palm dinner, said that the education companies it supports follow the group’s requirements, and that its grants benefit patients and providers.
The new company, Lighthouse Learning, was founded by Samuels and two businesspeople with experience in medical education, Jon Leibowitz and Susan Pioli, who put up an undisclosed amount of money to start the company.
They have recruited 11 specialists, many also from Harvard, to write the curriculum and recruit speakers for courses in cardiology, obstetrics, oncology, psychiatry, and other specialties. The work will be paid for by the sale of the curriculum to hospitals, medical societies, insurance companies, and other organizations that provide professional education to doctors, said Samuels, who is Lighthouse’s director of medical education.
While prices have not been set, the founders say organizations will eventually pay more because they will want to say the education they provide is free of industry influence, and rules will increasingly require that.
The curriculum directors will not teach other courses funded by drug companies, to further insulate them from industry influence, he said. And, the company’s advisory board, which includes former Harvard Medical School dean Dr. Joseph Martin, will review the curriculum directors’ other relationships with industry. Consulting fees and other industry ties will not be prohibited for those writing curricula, but such payments would have to be limited and disclosed, Samuels said.
Both Samuels and Leibowitz once had ties to M/C Communications — Samuels was medical director and Leibowitz was general manager — a company that accepts industry funding for continuing medical education, particularly for its Pri-Med courses in Boston and other cities. Samuels tried to start a neurology course for the company but he said it was not successful, partly because he was uncomfortable soliciting funding from drug companies.
Samuels said companies don’t need to have their drugs even mentioned to make medical education classes effective product marketing. Just paying for general courses on migraines, or Lyme disease, helps persuade doctors to intervene with treatment for more patients.
“If you plant in people’s minds that Lyme disease is ubiquitous and has all these side effects, you don’t have to say the word ‘ceftriaxone,’ ’’ he said, referring to an antibiotic approved for serious cases. “People become obsessed with Lyme disease.’’
M/C Communications said its model allows it to reach thousands of doctors with affordable programs.
But discomfort with the system has led some institutions, including Stanford University medical school and UMass Memorial Medical Center, to prohibit companies from funding specific courses in their continuing education programs, while a few, such as the University of Michigan, have banned commercial support altogether. Harvard Medical School has taken a more lenient approach, adopting a policy this year that prohibits funding of individual courses by just one company.
Amid the growing scrutiny and a sour economy, industry funding of physician education has dipped. In 2007, commercial support of programs accredited by Kopelow’s group — the Accreditation Council for Continuing Medical Education — was $1.2 billion, 48 percent of total funding. Last year, industry funding fell to $856 million, or 39 percent of the total.
Commercial support of Harvard’s large continuing medical education program also dropped, from 12 percent, or $3 million, in 2008, to 10 percent, or $2.4 million, last year.
Kopelow said that he doesn’t believe Lighthouse’s approach is unique, because 42 percent of accredited providers don’t take commercial support for their educational programs now.
But, Lighthouse executives say, most of those providers are small and don’t operate on a national scale. And, they said, the percentage is actually much lower if one counts money spent by industry on advertising and exhibits at educational conferences — money Lighthouse will not accept at its conferences. Last year, the industry spent $283 million on this category.
Eric Campbell, a researcher at Massachusetts General Hospital who specializes in conflict of interest in medicine, said, “It is unique to recognize that it’s inappropriate to pass on the cost of CME to patients in the form of higher drug prices’’ because of overprescribing. “Doctors should pay for their own education.’’
But, Campbell said, Lighthouse may find it more difficult than expected to be completely pristine. Drug companies, for example, can offer to pay doctors’ tuition to attend certain courses, thereby exerting influence in that way. “You can close down one avenue and drug companies will find another avenue pretty quickly,’’ he said.
Dr. Steven Nissen, chairman of the cardiology department at the Cleveland Clinic and an outspoken critic of industry influence in medicine, agrees that untangling these relationships is hard, if not impossible.
Nissen, who is directing the cardiology curriculum for Lighthouse, said it would be impossible to hire faculty who have no relationships to industry whatsoever. “The biggest name people, the people who have the most expertise and are going to draw an audience — they are people who work with industry,’’ Nissen said.
But, he said, he will try to minimize potential conflicts by not hiring doctors who are paid speakers for companies that sell drugs and devices.
“We are trying to do something here that serves as a model,’’ he said.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
“
