The system that keeps working doctors abreast of medical developments is too reliant on drug company funding and needs an overhaul, the Canadian Medical Association Journal said in an editorial published Tuesday.

The strongly worded editorial, written by the journal's editor-in-chief, said giving drug companies such control over the continuing medical education of doctors distorts medical practice and compromises the ethical underpinnings of the profession.

The author, Dr. Paul Hebert, placed much of the blame on doctors themselves, saying they have developed a sense of entitlement to the lavish perks often paired with continuing medical education or CME programs — things like tickets to the ballet or professional sporting events, cruises or access to exclusive golf courses.

"Over the years, the powerful pharmaceutical enticements have resulted in physicians believing that strong industry involvement is not only normal but also that they are entitled to receive the benefits. This culture of entitlement is one of the most difficult obstacles to overcome," Hebert wrote.

"We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals."

Doctors wooed by drug companies

Critics of the broad influence the pharmaceutical industry exerts over medical education, medical journals and the prescribing practices of doctors were quick to endorse Hebert's call.

"Hear, hear.… Three cheers for Dr. Hebert," said Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics, adding that the current system of CME "has very little to do with education and a great deal to do with marketing."

Although there have been efforts to crack down on some of the largesse, stories abound of doctors being offered family cruises if they agree to sit in on a few hours of lectures put on by the drug company that sponsored the cruise or CME sessions booked at world class golf courses.

"The problem is that you should always question the funding source," Hebert, an Ottawa cardiologist, said in an interview.

"Our professional ethics and our goal as physicians may or may not align with theirs. And what we've done is essentially fully aligned ourselves with a business approach, if you will. By default we've become as a profession entitled to receive all these gifts and all this support."

The regulatory bodies that license doctors require them to keep up with medical advances. Each dictates a set number of hours of CME credits doctors have to log every year to maintain their credentials.

But while the college may be counting a doctor's credits, there is no guarantee they are actually learning useful information in these sessions. "There's no requirement for testing at any of this. I mean basically for many of these things, all you're required to do is show up," Hebert said.

Nor is there any guarantee the information is balanced. Critics of the system suggest an industry-funded CME session on managing obese patients is more likely to focus on weight loss drugs than on  lifestyle changes needed to lose weight and keep it off.

Information often distorted

Hebert's editorial suggests that evidence shows education sponsored by drug and device makers "frequently distorts the topic selection, embellishes the positive elements of studies and downplays the adverse effects" — focusing attention on drug treatments and away from disease prevention, health promotion and non-pharmaceutical options, such as talk therapy for depression.

It proposes that an arm's-length "Institute of Continuing Health Education" be set up to design and run continuing education programs. It suggests funding could be derived from governments, the medical profession and a levy on profits from drug and medical device patents.

It called on the Canadian Academies of Health Sciences — perhaps in conjunction with its U.S. counterpart, the Institutes of Medicine — to start talks with stakeholders about how to change the system.

This type of change is long overdue, critics suggested. "They're on the gravy train," Schafer said, speaking of physicians. "They don't want to get off. 

The editorial noted that in the United States in 2006, $2.6 billion US was spent on continuing medical education for doctors, of which $1.45 billion came from drug or device makers.

It noted corresponding figures for Canada are not available, but said there was "no evidence that the situation is any different here."