It turns out that the rancorous CME debate that we consider to be modern is anything but, having its origins in the late 1950s, and early 1960s, when direct marketing to physicians in the guise of education heated up.
In 1961, for example, Charles D. May, the editor of the journal Pediatrics, wrote the article, “Selling drugs by educating physicians,” in which he bemoaned the body-snatching of medical education by the pharmaceutical industry:
A vicious cycle is created by a mad scramble for a share of the market: the doctor is made to feel he needs more “education” because of the prolific outpouring of strange brands but not really new drugs, produced for profit rather than to fill an essential purpose; and then the promoter offers to rescue him from confusion by a corresponding brand of “education.”
Now, nearly 50 years later, Dr. May’s quote still captures the essential damage done to medical practice by industry funding of CME.
Given recent events, it is ironic that one of the most outspoken advocates of industry sponsored medical education was a psychiatrist: Arthur Sackler, who was also a partner (and later owner) of the William Douglas MacAdams agency, a prominent pharmaceutical advertising firm. In his 1957 reply to reformers of CME, using an argument that has not changed in a half century, Sackler argued that physicians are fully able to read pharmaceutical marketing critically. “Pharmaceutical advertising,” he wrote, “has made one of the major contributions in the rapid dissemination of new therapeutic information.”
The JAMA paper also reminds us that long before Charles Grassley and the Senate Finance Committee began its current investigations, two congressional hearings had already led to some reforms: the Kefauver Hearings of 1959-1962, and the Kennedy hearings of the early 1990s. The Kennedy hearings forced PhRMA to develop its “voluntary” ethical codes, and also led ACCME to issue the first version of its Standards for Commercial Support.
However, the JAMA authors note that these reforms have accomplished little:
Nonetheless, the standardization movement of the 1990s did little to stem the growth of the medical education and communication industry, and instead may have helped to legitimize and create a legal defense for the industry, which has increased steadily since that time.
In concluding, the authors rightly lay the blame squarely in the lap of physicians, who have thus far been unwilling to bite the bullet and pay for their own medical education:
As advertising executive Pierre Garai noted in 1963: “The drug business is today, and will be tomorrow, what the doctors cause it to be. Drug advertising too.”Any responsible analysis of the role of pharmaceutical promotion in CME must account for the process by which individual physicians, organized medicine, and the regulatory state allowed and even encouraged this process to take place. Garai finished with the question: “We know what the doctors are today. What will they be tomorrow?”
Indeed, what will we be tomorrow? It is up to us.
As George Santayana once said, "Those who cannot remember the past are condemned to repeat it."