New York Times Publishes Letters in Response to My Op-ed

Thus far, The New York Times has published three letters in response to my op-ed calling for industry-free medical education. Here they are, and here are my responses.

To the Editor:

Daniel Carlat, in detailing how drug companies have co-opted medical education, says the solution is to revoke the accreditation of any continuing medical education financed by the drug industry (“Diagnosis: Conflict of Interest,” Op-Ed, June 13).

How about this? The practice would stop overnight if prominent physicians stopped accepting the exorbitant fees and emoluments the industry offers to participate in these programs. For years, the medical community has turned a blind eye to its complicity in this conflict of interest, comfortably sitting back and watching fingers being pointed at the pharmaceutical industry.

Truly a case of “physician, heal thyself.”

Cory Franklin, M.D.

Dear Dr. Franklin:

I agree with you. Physicians have become increasingly addicted to money from the pharmaceutical industry. There was a time when doctors would give educational lectures out of a sense of academic and civic duty. Now, most grand rounds lectures at medical schools are underwritten by companies, so that the presenter can make his or her requisite thousand bucks. Speaking from personal experience, I know that doctors make plenty of money by treating patients. It's time for a profession-wide detox from industry money.

To the Editor:

Daniel Carlat (“Diagnosis: Conflict of Interest,” Op-Ed, June 13) is simply wrong when he questions the educational value of continuing medical education programs supported by America’s pharmaceutical research companies.

Our voluntary marketing code for members states explicitly that when pharmaceutical research companies provide financial support for medical conferences, control over selection of content, faculty, educational methods, materials and venue belongs to accredited conference organizers and not the companies.

The Code on Interactions with Health Care Professionals helps to ensure that pharmaceutical companies can help health care providers receive valuable information about available medicines — with no strings attached. And there is no reason to believe that independent program organizers are jeopardizing their reputations or compromising their medical judgments because pharmaceutical companies have provided financing for continuing medical
education seminars.

Ken Johnson, Senior V.P.
Pharmaceutical Research and Manufacturers of America, Washington

Dear Mr. Johnson:

Is this really the best response that the pharmaceutical industry can muster? That America should simply trust in Pharma's "voluntary marketing code" to guide the foxes guarding the hen-house? The "no-strings attached" argument was utterly discredited by court documents in the successful suit against Parke Davis (later bought by Pfizer), convicted of illegal marketing of Neurontin for off-label uses. I suggest you read the fascinating article from Archives of Internal Medicine here. Parke Davis provided educational grants to several "independent program organizers," as you call them. The excerpt below from that article may give you a better sense of how well your voluntary code has worked.

"Teleconferences linking paid physician moderators with small groups of physicians were a method for reaching prescribers. Although these teleconferences were titled as educational events, an internal memo about 1 set of 143 teleconferences on epilepsy management noted that "the key goal of the teleconferences was to increase Neurontin new prescriptions by convincing non-prescribers to begin prescribing and current prescribers to increase their new prescription behavior". In some cases, Parke-Davis helped establish the agenda and was able to surreptitiously monitor teleconferences in progress. In 1 set of 39 calls organized through a medical education and communications company to discuss unapproved uses of gabapentin, an agenda was prepared for physician moderators directing them to discuss such topics as "how Neurontin evolved into a first line therapy option in your practice".

Mr. Johnson, I look forward to hearing more about how you expect us to trust your industry to police itself in the face of its history of corruption.

To the Editor:

Re “Diagnosis: Conflict of Interest,” by Daniel Carlat (Op-Ed, June 13): The Food and Drug Administration considers lectures and honorariums paid directly by pharmaceutical companies as promotion, not education.

When an activity is developed and certified by an accredited continuing medical education provider (a for-profit or nonprofit organization, university, hospital or medical society), it must adhere to unyielding criteria and standards. The standards are even more rigid when a pharmaceutical company provides the grant financing. The company can have no influence on the content or selection of faculty.

Sondra L. Moylan
President and Founder,
American Academy of Continuing Medical Education
Skillman, N.J., June 19, 2007

Dear Ms. Moylan:

I'm not quite certain why you bothered to write this letter. We all understand that there are regulations in place. However, we have seen over and over again that both the sponsoring companies and medical education companies are willing to break the rules in order to make more money. Rather than simply parroting the list of regulations, I would have preferred an explanation of why your own organization has chosen to produce educational programs that are entirely funded by drug companies?