Using a Pfizer Grant, Courses Aim to Avoid Bias
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.”
Stanford’s move was applauded by David J. Rothman, a professor and president of the Center on Medicine as a Profession at Columbia.
“It’s fair to say Stanford is once again leading the pack,” said Professor Rothman, who has written in The Journal of the American Medical Association about conflicts of interest in academic medicine.
“I will also confess I am surprised Pfizer is doing it,” he added, “and I don’t know how many more times they will give money with no strings attached.”
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.
Still, some saw inherent conflicts in the Pfizer connection.
“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.”
Stanford said the curriculum would focus on areas that needed improvement, like diabetes, cardiovascular disease, smoking cessation and infections. The university plans to use advanced technologies, including a simulated hospital, rather than lecturing.
“The Pfizer grant comes with no conditions, and the company will not be involved in developing the curriculum,” according to a medical school press release.
But 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. Pizzo, the Stanford dean said he was aware that the grant from Pfizer would receive some skepticism. “I think that’s appropriate because I have a certain guarded skepticism or optimism about this, too,” he said. “It remains to be seen how this eventually works.”
Drug and medical device companies have paid more than $1 billion a year for continuing medical education through universities, disease associations and private vendors, about half the total cost of the programs. The industry’s influence on topic selection, tone of presentations and advice given to doctors has spurred calls for reform from the Institute of Medicine, the Association of American Medical Colleges and the inspector general of the Department of Health and Human Services.
Pfizer has a checkered history of using such education courses to promote off-label use of its drugs. For instance Pfizer paid $2.3 billion last year to settle government fraud charges of deceptive marketing, including sponsoring supposedly independent programs promoting off-label uses for the pain drug Bextra.
In 2008, it became the first drug company to say it would no longer provide such money directly to
profit-making medical education companies, but only to universities and other nonprofits. But a $780,000 grant from Pfizer to the Canadian Medical Association for educational programs drew criticism because the company was given two seats on a six-member supervisory board. And a $3.4 million grant last year for the California Academy of Family Physicians to sponsor stop-smoking educational programs was questioned because Pfizer makes Chantix, a smoking cessation drug.
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.”
In September 2008, the Stanford medical school became the first in the nation to stop accepting industry financing for specific topics in postgraduate educational programs. It will accept only industry money that was pooled in a general fund for the education programs.
