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Letter Regarding Public Citizen Study Describing Medical Education Services Suppliers

David Leach, M.D.
Executive Director
Accreditation Council for Graduate Medical Education
1515 North State Street
Suite 2000
Chicago, IL 60610-4322

Dear Dr. Leach:

A new threat to objective, unbiased physician and resident education is rapidly proliferating. Medical education services suppliers (MESSs)L-1 disseminate purportedly objective information to physicians and residents in hospitals and other settings through grand rounds presentations, symposia, publications, and continuing medical education (CME) programs on behalf of their clients, predominantly pharmaceutical manufacturers. This is a newer and more insidious twist on the long-standing practice of direct drug company sponsorship of such medical education activities.

As the official–and only–organization reviewing and accrediting the over 7,700 graduate medical training programs in the United States, the ACGME is responsible for ensuring the quality of graduate medical education. Allowing MESSs or pharmaceutical companies to provide “educational” programs to resident physicians in ACGME-accredited residency programs is antithetical to this aim. We ask you to lead the ACGME to take strong action to prevent the distortion of objective medical education by commercial MESSs and the pharmaceutical industry by prohibiting, as a condition of accreditation, their ability to arrange and thereby commercially pollute important educational functions for residents such as grand rounds.

We have analyzed a survey conducted by the business periodical Medical Marketing & Media (MM&M)L-2 which sought information from 123 MESSs, of which 80 (65%) responded. The results of our study are described in detail in the enclosed report. Some of the more important findings were:

  • Based only on the 42 respondents who reported financial data,
  • the total U.S. revenue for the MESS industry was $643 million for 1999
  • the total revenue of the MESS industry increased 19% between 1998 and 1999
  • $289 million, or 45% of their revenue, was earned through providing grand rounds ($115 million), symposia ($114 million) and publications-related activities ($60 million)
  • On average, 76% of the clients named by each MESS were pharmaceutical manufacturers
  • 48% of respondents reported current or pending accreditation by the Accreditation Council for Continuing Medical Education

Our results suggest that MESSs often work on behalf of the pharmaceutical industry to provide physician “education” activities that simulate academic medicine’s methods of teaching and dissemination. Their sponsorship of physician education activities represents a clear conflict of interest. As long as MESSs act in the best interests of their clients and stockholders, they cannot be expected to simultaneously provide unbiased, objective physician education. The websites of MESSs in our analysis illustrate this “promotion-masquerading-as-education” charade, as some companies market themselves to potential clients precisely on the basis of their ability to be biased. For example, CPE Communications states, “Medical education is a powerful tool that can deliver your message to key audiences, and get those audiences to take action that benefits your product.”L-3

This problem affects residents when they attend a MESS-sponsored grand rounds lecture or symposium or receive a MESS-distributed publication. The proliferation of this for-profit industry raises a fundamental question about the nature of graduate medical education: Who is going to teach our post-graduate physicians as they train in this new millennium? The only satisfactory answer is “unbiased physicians.” Resident education and training will deteriorate if MESSs, and the pharmaceutical companies they are paid to represent, continue to organize biased educational activities to which residents are routinely exposed.

We strongly urge you to address this issue at the next meeting of the ACGME’s Executive Committee. The only practical solution that will preserve objective, evidence-based residency training is for the ACGME to prohibit MESSs and pharmaceutical companies from providing any “educational” activities whatsoever for resident physicians. This would require a ban of drug company or MESS-sponsored grand rounds presentations, noon conferences, and dinner meetings, as well as forbidding the distribution of textbooks, handbooks, pocket guides, reprints or any other publications by drug companies or MESSs to residents. Better yet, these for-profit industries should have no contact with resident physicians at all during post-graduate training; this would include prohibiting pens, notepads and other small non-educational gifts, drug company “information” tables in hospital corridors, social “happy hours,” fancy, non-educational dinners and reimbursement of residents’ registration and travel expenses for medical meetings when it is not commensurate with the time they have invested in the research projects.

We look forward to your response to these proposals.

Yours sincerely,

Joseph Ross
Research Fellow

Peter Lurie, MD, MPH
Deputy Director

Sidney M. Wolfe, MD

Public Citizen’s Health Research Group

Footnotes for letter:

L-1The term Medical Education Services Supplier, abbreviated MESS, is a term used by the medical marketing industry to describe a company that provides medical education services.

L-2 Anonymous. Medical education services suppliers, 1999 review. Medical Marketing & Media 1999; 34:40-80.

L-3Concepts in Professional Education and Communications. Why should you invest in medical education? Available at http://www.cpeducate.com/pages/CPEintroCont.html. Downloaded on July 19, 2000.