By Duff Wilson
The New York Times
January 11, 2010
Stanford University on Monday will announce plans to develop new continuing education programs for doctors that will be devoid of the drug industry influence that has often permeated such courses.
The work is being done with a $3 million grant — from the drug maker Pfizer.
Dr. Philip Pizzo, dean of the Stanford medical school, says Pfizer will have no say on how the three-year grant will be spent. The university plans to set up unbiased programs of postgraduate education on the Stanford campus rather than the industry-selected topics of the past that have been presented to rooms full of doctors at hotels and resorts.
“It’s a fundamental change,” Dr. Pizzo said Sunday, criticizing the drug industry for poisoning educational programs with marketing messages and doctors for “complicity” in taking speaker fees and expenses-paid trips. He called the grant “a novel rebooting.”
Pfizer, in a statement, said it wanted to help redefine how continuing medical education was financed to ensure the independence and patient benefit of the programs, which most doctors are required to take to maintain their state medical licenses.
“The announcement is self-satirizing,” said Dr. Adriane Fugh-Berman, a Georgetown University medical professor who has researched and written about industry influence in continuing medical education. “Pfizer’s interest in better ways to manipulate physicians is well-known.”
Dr. Fugh-Berman said that Pfizer has major products in two of the four areas that the Stanford press release suggested might be pursued: smoking cessation and heart disease.
Dr. Arnold S. Relman, a former editor of The New England Journal of Medicine, a Harvard professor emeritus, an outspoken critic of industry conflicts and a friend of Dr. Pizzo, said he could not understand the rationale behind the arrangement.
“If it is true — a big, big if — but if it is true that this money is being given without any strings at all and without any obligation on the part of Stanford to please Pfizer, then it’s arguable that it’s O.K.,” Dr. Relman said.
“But it’s just not a good idea for a profession that says it wants to be independent and trusted, a reliable source of information to the profession and the public about drugs, to take money from the drug company under any conditions.”
http://www.nytimes.com/2010/01/11/business/11drug.html?ref=health
Comment:
By Don McCanne, MD
This tempering of the contingencies attached to Pfizer’s grant to Stanford’s continuing medical education program (CME) seems like a very small anecdote in the overall picture of health care reform, but it has greater significance than would appear at first blush.
Stanford’s Dean Philip Pizzo has a well deserved reputation for taking principled stands on the ethics of medical education and health care in general. This agreement to accept the Pfizer grant only on the condition that its use in their CME program be exclusively controlled by Stanford, without further input by Pfizer, is another step towards Dr. Pizzo’s goal of a system largely freed from the albatross of ethical compromise.
Are there any reasons that Stanford should not have accepted these funds? The first and most obvious reason is that this expense for Pfizer will be passed on to patients in the form of higher drug prices, already a serious problem that policy makers face.
Also, since Pfizer can deduct this as a business expense, the tax subsidies that we are providing are being turned over to Pfizer, which has control over how to distribute those funds. Do we really believe that a private, investor-owned pharmaceutical corporation has a greater ethical sense and wisdom in determining the use of our taxpayer funds than would our own public stewards? Likely Stanford will make very good use of the funds, but of the options for use of the taxpayer-funded component, is that the best use? It doesn’t seem right to turn that decision over to Pfizer, especially when it appears that the CME programs may still support Pfizer products, but only if Stanford decides so (certainly an ethical problem if and when it comes time to renew the Pfizer grant).
CME programs provide a social good: better health care for everyone. Public funding would prevent such ethical compromises and would help to ensure that CME programs have a mission to improve patient care rather than a mission to advance the pecuniary interests of pharmaceutical and medical-tech firms.
The ethical premise behind the concept of a single payer national health program – an improved Medicare for all – resets the primary mission for our entire health care system from one of private entrepreneurialism to one of service for the benefit of patients.
Dean Pizzo is to be admired for trying to achieve the best under the confines of our current dysfunctional system. You work with what you have, until you have something better.
The greater significance of this anecdote is that the rules under which we operate are wrong, and we need to change them, not just work within their confines as Congress is trying to do. We need a single payer monopsony that belongs to all of us – the people of this nation.