pharmafile | October 10, 2016 | Feature | Business Services, Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing | educated, funding, medical education, transparency
The pharmaceutical industry has always occupied a central role in medical education. In theory, pharma’s interest in education makes sense. Highly trained and efficient medical professionals mean that patients receive better care. Better care means access to high quality medications and, obviously, that’s where pharmaceutical companies come in. Increasingly, as the public perception of pharma gradually got worse, its funding of medical education became yet another stick to beat pharma with. However, it is clearly not as straightforward as that from either of those perspectives. The industry’s relationship with medical education has, and continues to, evolve.
There are countless examples in the public domain of medical professionals receiving funding or payments from the pharmaceutical industry. In July, the Association of the British Pharmaceutical Industry (ABPI) launched Disclosure UK, a database that lists the details of payments made to doctors, nurses and pharmacists, as well as other health professionals and health organisations in the UK. The database lists £340.3 million in payments from 109 pharmaceutical companies in the UK in 2015 categorised under research and non-research payments. Under the non-research payments includes, of course, pharma’s contribution to medical education.
It would be fair to say that there’s not a lot of fence sitting when it comes to pharma’s role in medical education. Robert Goodman, writing in the journal Perspectives in Biology and Medicine, says: “Other than the perceived financial need for industry funding, it is not at clear that there is a role – or any need – for industry involvement in medical education.” Ed Silverman, writing in the Wall Street Journal, highlights: “Amid ongoing scrutiny of industry influence over medical practice and research, new figures show that companies increased their spending on continuing medical education last year by 2%.”
Avorn and Choudry, the latter a researcher in Harvard Medical School, acknowledging the key roles that pharma plays in wider healthcare but nevertheless highlight that: “in the realm of teaching, whether of medical students, house officers, or practitioners, there is growing concern that educational activities should not be supported or influenced by companies whose profitability and very existence depend on the sales volume of the products they make.”
These researchers attempt to provide an even handed approach to their opposition to direct industry funding. They say: “Our position that industry should not directly support educational programmes is not ideologically driven. Rather, it is based on the expectation that medical knowledge can be transferred most efficiently and with the least distortion if those responsible for this activity have minimal commercial interest in the topic being represented.”
While criticism of pharma’s role in medical education really began to gather steam in the last decade or so, the industry has acted relatively quickly in both emphasising the importance of continuing its role in this field, and reassuring of its focus on patients getting the best care in the process. As Pharmafocus has pointed out in past articles, online is becoming an important medium for medical professionals to receive education.
One such online platform is called Therapeutics PLUS, which was funded by Pfizer and was designed to support non-medical prescribers with their continued professional development in areas such as chronic asthma management, neuropathic pain and smoking cessation. National account manager Jason Miller keenly stressed that the company was not looking for a direct return on its investment in creating the platform. Its value would be judged on the numbers using the site and the relationship building that took place between pharmacists and other non-medical prescribers. For Pfizer, the value it derived through this funding was not direct financial gain, but partnerships.
The ABPI emphasises this role and the value that both medical professionals and the pharmaceutical industry derives from this relationship. Head of medical affairs, Dr Jacintha Sivarajah, told Pharmafocus: “Ongoing medical education for doctors, nurses and pharmacists is an important part of ensuring that UK patients receive the right medicine at the right time. Once a doctor is qualified for example, the amount of educational events provided and paid for by the NHS is limited. We recognise the importance of ongoing education, as well as the financial restrictions in the NHS – we offer medical and education services to support health professionals stay ahead in their knowledge of disease areas and treatments.
“These services are strictly regulated under the ABPI Code where they are identified as medical and educational goods and services. We also offer health professionals sponsorship to attend educational events or fees and expenses to attend such events – again these are regulated under the ABPI Code. By participating in educational events, doctors, nurses and pharmacists have the opportunity to hear first-hand about new research and advances in medical care. In turn, they can adapt their practise to provide up-to-date evidence-based care to their patients.”
With a transparent system in place, pharma must utilise the best resources available to fund education that is open and honest about how it operates.
When businesses began to realise the potential of the internet to reach potential customers, users began to be bombarded with adverts from all sizes. Although popups and clickbait ads still exist, there has been a concerted move towards winning over potential customers through the strength of your content. You want people to forget for a moment that you’re selling a product, and learn to trust the content you create as a brand. Once they like and trust what you have to say they may not be more likely to use or buy your product or service, but it nevertheless establishes you as an authority on a particular topic.
Before the screening of the TV series, Narcos, the Wall Street Journal ran a really thoroughly detailed piece on the events that help shape modern Colombia. It was well-researched, insightful and provided an excellent account of how Pablo Escobar became a feared cocaine baron. At the very end of the piece, it indicated that it was promotional content provided by Netflix to promote their show. By this time, however, it had had the desired effect. By not being directly sold to and given some excellent information, or content, Netflix was solidifying its brand and possibly making readers more likely to consume their product which was, in this case, watching the show. It was demonstrating value.
There is no reason why pharma cannot do the same in its approach to medical education.
While not directly promoting its products to healthcare professionals, it can provide something that will really add value for the healthcare professional and contribute in a meaningful way to their knowledge. Engaging with the pharmaceutical industry need not be something that may hinder your professionalism in the eyes of peers and patients. It can be a mutually beneficial arrangement.
Shanida Nataraja, writing in the journal of the European Medical Writers Association, points out: “They must target the right messages to the right audience, but should do so in an unbiased and balanced manner. And, most importantly, they must never lose sight of the ultimate goal of medical education – to drive improvements in patient care.”
Pharma doesn’t always confine its innovation to R&D. In terms of medical education it has, in recent years, stepped up to the mark in providing these sorts of experience to healthcare professionals with the old paradigm of doctors paid to give positive opinions perhaps not completely invalidated, but certainly weakened somewhat.
The ABPI’s Sivarajah adds: “Medical and education services are one of the categories disclosed on the database, along with sponsorship and fees and expenses. Anyone can visit the database and find out what payments a doctor, nurse or pharmacist have received from industry and what it was for, provided a doctor, nurse or pharmacist has given their consent. We encourage all health professionals to agree to disclosing these payments – we’re proud of the work we do together.”
A two-pronged approach of greater transparency, such as the ABPI’s Disclosure index, and the focus on content-led non-promotional education could lead to the pharmaceutical industry contributing to medical education, with everyone getting on board with it in the process.
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