According to the New York Times, an investigation by the US Senate Finance Committee of pharmaceutical companies' use of "educational" grants is producing some interesting results.
In 2004, the article reported that 23 pharma companies spent about $1.47 billion on educational grants, up from $1.23 billion in 2003. Such grants support a wide range of activities by medical organizations and medical schools. The committee's main concern is whether these educational activities have been used by pharmaceutical companies to promote "off-label" use of drugs, that is, use of drugs for reasons other than those officially approved by the US Food and Drug Administration (FDA) and which thus appear on the drugs' label. Physicians may legally use drugs off-label at their discretion, but drug companies cannot legally promote such usage.
Some bits of information about how drug companies decide who gets "educational grants" were particularly interesting. First of all, there seem to be no accepted procedures for making these decisions. At best, the Pharmaceutical Research and Manufacturers of America (PhRMA) has "voluntary guidelines" for how this should be done, but the extent to which manufacturers follow them is unclear.
However, the Finance Committee seems to have found that these decisions are often in the hands of marketing executives. According to the Times, for example, the Committee found that educational grants made by Johnson & Johnson about the marketing of Propulsid (now off the market), "were being authorized by executives with titles that included product director, gastroenterology product director, Propulsid brand product director and director of segment marketing." Furthermore, a letter to the company from the Committee said "it appears that many manufacturers' sales and/or marketing personnel still have a role in originating or evaluating grant requests." Furthermore, many of the grants the company made "have no apparent relation to education." Finally, the Committee noted that some grants went to patient advocacy groups who "may become so reliant on industry funding that it may compromise their independence."
Combined with other evidence that pharmaceutical companies and other organizations may use stealth marketing to promote their interest, this story suggests that physicians need to be increasingly skeptical of the motivation behind the commercially sponsored "educational" activities to which they are often exposed.
If pharmaceutical companies' "unrestricted educational grants" are really meant for educational purposes, why should they be controlled by marketing executives?
Your last point is well made.
ReplyDeleteThe "disease mongering" aspect, using patient advocacy groups has been particularly active over the past 5-10 years.
Why? In part its because they are usually run on a shoestring and therefore more "malleable".
MDs have become too expensive, in some cases!!!