We need to limit the dependence of medical continuing education on industry funding – but who should pay?

I recently attended the Faculty of Pain Medicine’s Spring Meeting at Coolum. The Faculty has just launched a new online education initiative in conjunction with the Royal Australian College of GPs (RACGP) which aims to start closing the yawning gap in knowledge between the average health professional and the state of the art.

One of the really impressive things about the program is that is has deliberately been done without taking a cent from the pharma industry. Most of the $200K plus that it has cost has come from a grant from the Bupa Foundation, a charity which funds initiatives aimed at improving the health of the Australian population.

One the speakers at the weekend was Dr Jerome Schofferman from the US who researches and lectures on spine care and medical ethics. There is abundant research that doctors and other health professionals are as susceptible as everyone else to smart sales techniques.

Schofferman suggests that industry should be allowed to sponsor conferences and events, but they should be confined to the trade or exhibition area only. Branding on programs, speaker slides and in accommodation areas should be banned, and delegates should free to enter and leave the conference rooms without having to run the gauntlet of trade displays.

Incredibly, the medical-industrial conglomerates directly sponsor as much as 60% of continuing professional development (CPD) in the US, and Australia may well be similar. The Medical Board of Australia enforces mandatory participation in a CPD program, and every professional body runs their own. That’s a lot of education that somebody has to pay for if the current major sponsors are discouraged.

Given that it costs a heap and is compulsory, who should bear the cost? Travelling to conferences and staying at hotels is expensive and time-consuming. For those in private practice there is the double blow of not earning while away.

In Victoria, at least, there is an allowance that public hospital doctors can use to get refunds for such expenses. This has been a very useful tool in giving some freedom from industry-sponsored trips to big conferences, but it does not include GPs or private practitioners. The arrangements to relieve the CPD costs of nurses and allied health practitioners in the public sector are almost non-existent by comparison.

The Medicines Australia surveillance of pharma companies is one of the strictest in the world, and has been helpful in limiting the marketing of participating firms. A revised code is undergoing a lobbyist-led watering down process, but a simpler option is for pharma companies to just opt out of the Medicines Australia self-regulation framework. At present there’s nothing legally stopping them from doing so.

The marketing of health-related devices (implants, orthoses, gadgets) is still so loosely regulated it would make Big Pharma blush. Perhaps that’s a topic for another day.

What we need to counter the problem is for CPD provision by Colleges and Faculties to become more professional. The RACGP is already doing this very well. Industry sponsorship of CPD should be paid into a pool which is distributed according to educational priorities of learners, not commercial interests of sponsors. Marketing activities at conferences should be restricted to the trade and exhibition areas.

But the public health sector needs to do more to support the compulsory CPD needs of its employees as well. The more often that health professionals can attend non-commercial CPD sessions, the more likely they are to be getting good information rather than spin.

And finally, individual health practitioners of all stripes need to ensure that they don’t continue to encourage industry to spend on marketing disguised as education by being very choosy about what events they attend and how they interact with sales reps.

There are many guidelines which set out how ethical and mutually beneficial relationships with industry can be observed. I’d be interested to hear what other initiatives are out there to help separate CPD from industry influence. We owe it to ourselves and to our patients to seek them out and follow them.

The author is Chair of the CPD Committee for the Faculty of Pain Medicine and is currently helping organize a large scientific meeting for next year.

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7 Comments sorted by

  1. Sue Ieraci

    Public hospital clinician

    Good discussion - thanks Michael. The Australasian College for Emergency Medicine has also moved to both conferences and journal free of pharmaceutical sponsorship.

    As a public hospital employee, I have provision for study and conference expenses in lieu of salary, benefits which are "cashed out" in private practice. Perhaps the approach of the non-salaried practitioner should be to set aside a fund for continuing education from their earnings.

    In my experience, the greatest limiting factor…

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  4. Luke Weston

    Physicist / electronic engineer

    I bet there's no interest in decoupling of CPD funding for "alternative health" practitioners away from the Big Quackery/homeopathy/vitamins/"supplements" industry.

    But then again "alternative" practitioners are usually not decoupled from the Big Snakeoil salesmen at all, they're usually overlapping and one and the same.

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  5. Ken Harvey

    logged in via Facebook

    The NPS is funded by the Australian government to provide independent education to students, doctors (primarily GPs), pharmacists, nurses and consumers. See: http://www.nps.org.au/.

    They have excellent Internet learning resources including a problem based prescription writing curriculum based on the WHO Guide to Good Prescribing, see: http://nps.unisa.edu.au/new/index.htm

    Also additional modules are available such as "Finding evidence - Recognize hype", see: http://nps.lamsinternational.com/moodle/index.php

    Well worth a look!

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    1. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Ken Harvey

      Thanks for bringing this to our attention Ken.

      The NPS is a great source of information from an independent source, and they do provide some really helpful CPD-type activities such as practice audits and so on. I wasn't aware of the full range of stuff they have available now.

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  6. Sue Ieraci

    Public hospital clinician

    What do fellow readers think of this model for training and education, copied from a website selling homeopathic remedies:

    "(Name removed) Expert Training

    Will you be the ‘expert’ on how to learn & earn in your spare time?

    www.(name removed)Expert.com.au is now ready and available for you to boost your knowledge and expertise on our broad range of homeopathic products. Our modules are broken down into 3 bite size sessions for each category, allowing you to learn at your own pace. You can…

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