Pharmaceutical industry support for continuing medical education: Is it time to disengage?

Over the past two decades, the relationship between the medical profession and the pharmaceutical industry has been a source of intense debate, largely because of concern that it may harm patients through inappropriate prescribing, increase the costs of health care through the unjustified use of expensive pharmaceuticals and ultimately subvert the (proper) goals of medicine, medical education and medical research.1–4 Recent well-publicised instances of companies using multiple means, including continuing medical education (CME), to promote off-label use of their drugs (including AstraZeneca, which paid US$520 million in 2010 to settle charges that it promoted unapproved use of the antipsychotic quetiapine, and Eli Lilly, which paid US$1.415 billion in 2009 in criminal and civil penalties for promoting off-label use of olanzapine) have only served to heighten concerns that doctors can be persuaded, through direct or indirect means, to further the commercial interest of the pharmaceutical industry.5 It is uncertain exactly how much money the pharmaceutical industry spends on promoting its products to medical practitioners through detailing, advertising, gifts and drug samples, and support for travel, scientific meetings and continuing medical education. But it is a very large amount – a recent estimate put it at more than $US50 billion per year in the United States alone, with at least $US1–2 billion being spent on CME – and it is effectiv