As a VA employee, there has been increasing pressure to curtail the relationship with the pharmaceutical and medical device industry. This extends from work to my professional interests outside the office, as my status as a VA employee doesn’t end when I leave work. It influences decisions about the types of professional programming I participate in. VA regards it as a potential conflict of interest—should I be receiving any benefit while participating in education? Will it influence my ability to make impartial decisions about what is best for my patient?
Of course, education doesn’t stop when we graduate from school. Continuing education hours are essential to our practice. They are the pathway to continued certification, and confirmation that our practice is consistent with community and evidence based standards. The networking that takes place at these events is priceless.
However, there is reason for pause. Healthcare professionals have been the beneficiaries of large sums money, from our industry partners, for education. The Pew Institute reports that in 2012, the pharmaceutical industry spent 2.1 billion on educational and promotional meetings for healthcare providers. The medical device and pharma industries contributed 32% of all funding for CME in 2011.1 Brody(2009) states industry believes that it will recoup $3.56 in increased sales for every dollar that it invests in CME. 2 CE and pharma programs are not synonymous, but they are often linked by the funding source. It certainly calls into question the potential for bias. There is mounting public and congressional concern that healthcare has been unduly influenced by pharmaceutical funding for professional education.
Johns Hopkins, among many other healthcare organizations, recommends that their staff end the practice of relying on industry to support their professional society events. Their staff must pay for their own food at such activities. The underlying rationale is that gifts carry an “implied expectation of reciprocity”.3 Anything that incentivizes a product may affect subsequent decisions for that product. Even if we think we can maintain impartiality, the appearance to others is that we have not.
VA allows its employees to accept gifts up to $20 per occasion, or a total of $50 per calendar year. 4 This is relatively consistent with most federal employers. Given that most sponsored dinners cost at least $75 per person, VA employees must pay for their own food at these events. It has effectively stopped participation in most industry sponsored meals.
The Physicians Payment Sunshine Act, part of the Affordable Care Act, requires that any transfer of value or payments given to a physician or teaching hospital are disclosed to the Centers for Medicare and Medicaid Services (CMS). Nurse practitioners and Physician Assistants do not fall under the national mandate for reporting, though some states do require it. There has been some talk that other health care professionals will be included in the reporting, such as nurses, dieticians, and pharmacists. I didn’t have much success finding information on their website: https://openpaymentsdata.cms.gov/
Another website had a lot more easily accessible information, with better delineation between the type of funding that was supplied—research, speaking, or food and beverage. ProPublica, a website touting Journalism in the Public Interest, has a Dollars for Docs look up site, where anyone can check their provider to see how much money has been received from pharma: http://projects.propublica.org/docdollars/
The public access to reporting sites has put a chill in the air. We do need to avoid the appearance that commercial interests are guiding our treatment and prescribing recommendations. Transparency in our relationship with industry is essential to maintaining the public trust, and our credibility. That being said, I have always found our industry partners to be an excellent source of information about their products, and patient education materials.
This sea change has implications for us at AZ AADE. Our meetings may look different —they will be at lower cost venues, and the meals may not be quite as pricey. Non-members are being charged for attending AZ AADE events. It may make it more difficult for us to support certain programs. We are starting to investigate unrestricted gifts and grants from the pharmaceutical industry to support larger continuing education programs. Your participation and thoughts are more important than ever. Time to get creative—as our need for continuing education isn’t going away any time soon.
1. The Pew Charitable Trusts (2013). Retrieved October 26, 2014 from http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2013/11/11/persuading-the-prescribers-pharmaceutical-industry-marketing-and-its-influence-on-physicians-and-patients
2. Brody, H. (2009). Journal of Law and Medical Ethics 37(3). Pharmaceutical industry financial support for medical education: benefit, or undue influence? Retrieved October 26, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/19723256
3. Johns Hopkins Medicine Policy on Interaction with Industry (2011). Retrieved October 26, 2014 from http://www.hopkinsmedicine.org/Research/OPC/Policy_Industry_Interaction/policy_interaction_industry.html
4. Department of Veterans Affairs (2012). Promotion of drugs and drug-related supplies by pharmaceutical company representatives. Retrieved October 26, 2014 from http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2852