Physician education and the pharmaceutical industry.

I n the current issue of CHEST (see pages 1255 and 1257), two thoughtful leaders of the American College of Chest Physicians (ACCP) frame an issue that confronts most physicians today—the relationship between us, the physicians, and the medical products industry. This relationship connects those who sell medical products (pharmaceutical or technology) and those who prescribe the use of those products (we, the physicians). More specifically, the comments written by Basil Varkey, MD, FCCP, and Alvin Lever, MA, FCCP (Hon), address the role of the pharmaceutical industry in physician education. This is an intellectual, civil exchange between two individuals who are united in their support of the ACCP: Dr. Varkey, a longtime ACCP Fellow, and Mr. Lever, the Executive Vice President and Chief Executive Officer (CEO) of the organization. As an individual, Dr. Varkey raises two major issues. First, he cites the connection between the corporations who paid for prominent advertising spots at CHEST 2000 and the College itself. Second, he expresses concerns about the apparent educational partnership of the College with corporations. Mr. Lever responds to the former concern with an earnest explanation and remedy. He takes up the latter by detailing the rules that regulate accredited continuing medical education in this country, and by which the College abides in its conduct of continuing medical education. The issues are forthright and deserve the attention of the College and its members. There were Fellows at CHEST 2000 who noticed and expressed to me and other ACCP leaders their concerns about the corporate presence. They often cited, specifically, as does Dr. Varkey, the badges and the large screen at the bottom of the entry escalators. In recent years, I have had the opportunity to attend various medical meetings, and the commercialism at the CHEST meeting is not discernibly different from that observed at those meetings. Commercialism is prevalent throughout our field and society as a whole (examine the Olympics, for example). We, as sophisticated consumers outside our profession, are accustomed, I believe, to tuning out advertisements of all sorts at any given time. One week after the CHEST meeting in San Francisco, I spoke briefly at the American Association of Blood Banks in Washington, DC. There, I noted that everyone’s badge was emblazoned with a name of a corporate sponsor. Intrigued by the criticism at CHEST 2000, I took an informal (hardly scientific) poll. The response was best characterized as stunned indifference: “I never really thought about it,” one said; and “I suppose we need the money to support this big meeting,” said another. Most of those individuals I queried believed that they personally had no decision-making power related to the company in question. Clearly, what appears to one physician as a corporation buying undue influence through advertising dollars is to another physician a “nice badge” or a “good meeting” without any perceived impropriety or even a legitimate connection between the desire of the industry to promote their products and the educational essence of the meeting. The second issue raised by Dr. Varkey and to which Mr. Lever responded is more complex. While we can advocate a buyer-beware stance with respect to medical advertising, that which we, as a College, put forth as education must indeed be free from undue influence. It is difficult, if not impossible, for listeners to be wary if they are ignorant of hidden support or conflicts that exist, thus the many disclosure policies in use today. As a former Chair of the ACCP Continuing Education Committee (CEC), I am familiar with the processes cited by Mr. Lever. The United States Accreditation Council for Continuing Medical Education (ACCME) strives to accredit only high-quality, untainted medical education. The ACCP complies scrupulously with the ACCME requirements. Our own CEC even goes beyond the requirements, but nothing absolutely prevents unscrupulous individuals from promoting their own best interests to the detriment of those they serve. Our organizational process is intended to protect, and in my opinion does protect, the slightly wary physician from undue influence, and thus, ensures the integrity of the College’s educational activities. For me, all this boils down to individual vs organizational responsibility. On one hand, we have the appropriate concerns raised by individuals. In this particular instance, it is a single individual’s attention (Dr. Varkey), but there were others who mentioned such concerns to me at CHEST 2000. On the other hand, from the CEO of one of the foremost medical organizations of this country, we have a response detailing concerns of an organization. This response is an organizational, group-process-oriented one—as it should be. It remains the responsibility of an individual to be wary—caveat emptor. No organization can ever reflect the totality of the various ethical beliefs and economic philosophies of its membership. Instead, an organization must set reasonable, rather widely supported universal standards and define a process that will prevent it from veering imperceptibly off course. Individuals CHEST editorials