Schools need regulation to prevent industry promotion during clinical training
A version of this commentary appeared in the Globe and Mail, Calgary Herald and the Saskatoon Star Phoenix
Most Canadians might be surprised to learn that medical students in Canada are routinely taught by faculty who have financial ties, and work in partnership, with drug companies. Conflict of interest (COI) policies at medical schools are important to ensure that students get an unbiased education based on the best available clinical evidence, free of industry-sponsored, commercially-driven information. After all these students go on to become our doctors, and we want the best doctors education can provide.
So, do medical schools in Canada lack appropriate conflict of interest policies or are they simply not following them?
In a study published this week in PloS One, we examined the COI policies at all 17 medical schools across the country. Our findings reveal a glaring problem, and something that should concern all of us. The majority of medical schools (12 of 17) have generally weak or non-existent COI policies, and four schools had policies that were moderately restrictive. Only one medical school — WesternUniversity — had stringent COI rules.
In other words, the bulk of our doctors-in-training in Canada are receiving health information that is potentially biased and misleading.
Here’s a telling example. Between 2002 and 2006, the University of Toronto held a pain management course for medical and other health science professional students that was partly funded by grants from Purdue Pharma LP, the maker of OxyContin. As part of the course, a chronic pain management book — funded and copyrighted by Purdue Pharma — was distributed to the students free of charge by a lecturer who worked in partnership with Purdue Pharma and was external to University of Toronto.
The wording in the book exaggerated both the benefits and the approved uses for these medications, based on the current evidence at that time. Despite recognition of these concerns by the university after a student complained, those who attended the sessions were never informed of the bias or the problematic content of the lectures and book (which was used in a related course up to 2010).
The most poorly regulated areas noted in our study include curriculum selection, receiving free drug samples, visits from pharmaceutical sales representatives and taking part in speaking engagements on behalf of pharmaceutical companies.
Bottom line: Unrestrictive policies allow industry to influence medical residents’ education about appropriate, effective and safe medicines, as well as prescribing choices.
Free drug samples have been found to increase the likelihood that medical residents will choose to provide medications to patients that cost more than equally effective prescription treatments, or other non-pharmaceutical options. Frequent visits by drug sales representatives are associated with influencing prescribing practices, resulting in more frequent prescribing and poorer prescribing quality.
The biggest concern, however, is the lack of education provided to medical students about the pervasiveness and effects of COI relationships with drug companies. Without such guidance, medical students, who will become prescribing physicians, graduate without being fully equipped to deal with either potential conflicts of interest in medical practice, or the influence of industry promotion on clinical judgement.
Our findings mean that industry has the ability to influence the resources provided and information that is taught to medical students. Without effective, stringent policies to regulate industry’s interactions with medical students and faculty, drug companies are granted the ability to be present in medical schools and play notably influential roles in the clinical training of medical students.
If we want the best doctors in Canada, our medical schools need to revise and improve their policies to regulate conflicts of interest between medical faculty, residents and the pharmaceutical industry. These policies should address the medical curriculum and the ways in which relationships with pharmaceutical firms may affect the attitudes and information that is taught to medical students.
Medical students should be educated by medical faculty using the best available clinical evidence that is unbiased by industry so that when medical students graduate, they are able to provide their patients with the best, most effective, and safest treatments possible.
Adrienne Shnier is a PhD candidate in the Health Policy & Equity program at York University, Intern with the Patients’ Association of Canada (PAC), and Research Fellow with the Pharmaceutical Policy Research Collaboration (PPRC). Joel Lexchin is an advisor with EvidenceNetwork.ca, teaches health policy at York University and works as an emergency physician at the University Health Network.
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