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.