Wednesday, May 21, 2008

AMA CEJA Proposes Strong Policy on Medical Education

One of the unfortunate elements of organized medicine's response to pharamceutical industry influence over medical practice, to date, is the tepid ethical guidelines proposed by groups like the AMA, that could be read as trying to prevent the most embarrassing excesses while leaving the status quo intact. This may be changing, as the AMA's Council on Ethical and Judicial Affairs is now proposing a set of recommendations on medical education, specifically, which appropriately joins the reasonably strong statements recently put forward by the AAMC Task Force (http://brodyhooked.blogspot.com/2008/04/aamc-has-spoken-more-or-less-pharm-free.html; see comments for arguments that ther AAMC statement is not as strong as it should be):

http://www.ama-assn.org/ama1/pub/upload/mm/471/ceja1-2.doc

The principal recommendations are worth quoting in full:

  • Individual physicians and institutions of medicine, such as medical schools, teaching hospitals, and professional organizations (including state and medical specialty societies) must not accept industry funding to support professional education activities. Exception should be made for technical training when new diagnostic or therapeutic devices and techniques are introduced. Once expertise in the use of previously new devices has developed within the professional community, continuing industry involvement in educating practitioners is no longer warranted.
  • Medical schools and teaching hospitals are learning environments for future physicians at a critical, formative phase in their careers and have special responsibilities to create and foster learning and work environments that instill professional values, norms, and expectations. They must limit, to the greatest extent possible, industry marketing and promotional activities on their campuses. They have a further responsibility to educate trainees about how to interact with industry and their representatives, especially if and when trainees choose to engage industry in varying capacities after residency and fellowship training.
  • The medical profession must work together to identify the most effective modes of instruction and evaluation for physician learners. It must then more efficiently develop and disseminate educational programming that serves the educational needs of all physicians. The profession must obtain more noncommercial funding of professional education activities.

And one passage in the body of the report was especially music to my ears: We are not convinced that attempting to manage industry influence in professional education is a prudent use of resources. Rather, avoiding the influence altogether is essential to ensuring the integrity of professional education. Avoiding influence-creating situations altogether is effective, simple, and does not place the burden of sustaining objectivity entirely on individual physicians.

The current word on the street is that some members of CEJA are worried that when this report goes to the AMA House of Delegates next month, the champions of the Pharma gravy train will take strong measures to eviscerate it while few defenders of the report will appear. How the AMA House of Delegates and leadership responds to this report will tell us a lot about whether the winds are shifting as much as some recent events would seem to signal.

Now, of course, if CEJA would only go back and write similarly strong language about the average medical practitioner's relationship with Pharma--or is that asking way too much of what the AMA could stomach?

3 comments:

Rod Malcolm said...

Howard, your blogs are always great, and this one is another exemplary example. Thanks for always asking the right questions. Hope you don't mind me quoting you occasionally in my blog over at novusdetox.com, where I comment regularly on Big Pharma ethics. Again, thanks!

Anonymous said...

Apparently you have mis-judged both the direction and the strength of the "winds". And all of us living in the real world hope that they never point in your direction -- a direction that leads to a collectivist world where doctors are viewed as slaves to patients rather than individuals who can make their own decisions and evaluate their own worth. Socialism has no place in the US, be it politics or healthcare.

sajudivakar said...

hello....your blog is good.