Strong force of industry

I thank Dr Spithoff for the timely article “Industry involvement in continuing medical education. Time to say no.”¹ The pharmaceutical marketing industry has found it increasingly difficult to access physicians through conventional channels (office detailing, company-sponsored dinners, etc). Instead they have found a new detailing channel: the university academic or researcher.

So now we have the “perfect storm”: industry-sponsored research and industry-sponsored researchers who in turn market their research findings (and a company’s new products) to physicians who attend continuing medical education events and are anxious to learn the latest from their respected teachers.

Furthermore, these same academic researchers or experts and their colleagues then write clinical practice guidelines supported by their research findings. These guidelines are then disseminated by the guideline agencies through continuing medical education events and lecture tours often with the financial assistance of the pharmaceutical industry. The follow-up can even be a “knowledge transfer” exercise hosted by the College of Family Physicians of Canada and funded by an educational grant from the pharmaceutical industry.

Although disclosures are made and the industry usually has no say in the content, the sponsorship relationship remains a very strong force in “getting the message out.” One of the most obvious examples of this marketing scheme has been the massive effort to launch dabigatran in Canada. The result was as follows: the most commonly prescribed new oral anticoagulant in Ontario between 2010 and 2012 was 110 mg of dabigatran² despite it being inferior to warfarin in the prevention of ischemic stroke (110 mg or 150 mg of dabigatran vs warfarin)³ and having the same rate of serious hemorrhage (including intracranial hemorrhage) as warfarin.²

You are absolutely correct, Dr Spithoff. It is time to say no!

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