CardioExchange Archive

Everyone knows that medical information flows out of medical centers and schools; research institutions and the NIH; pharmaceutical companies; journals; and medical societies. But one important information source — medical communication companies (MCCs) — “are among the most significant but least analyzed health care stakeholders,” according to Sheila Rothman and colleagues. In a new report in JAMA, they set out to explore the important but poorly understood role of MCCs.

Until recently, little has been known about these companies. But in recent years, either as a result of legal settlements with the government or public pressure, 14 pharmaceutical and device companies have published their grant awards on the internet. In 2010, the authors report, the 14 companies gave over $170 million to MCCs, “more funds than any other recipient, including academic medical centers, professional associations, and research organizations.” Almost all the MCCs were for-profit companies. The top recipient of industry funds was Medscape/WebMD, which received more than $20 million, representing 12% of all awards to the MCCs.

One major source of concern involves online CME activities produced by the companies. This, write the authors, “allows them the opportunity to collect personal data and create digital profiles. Although MCCs did not elicit users’ explicit consent, they interpreted participating in a CME course and navigating the website as an implicit agreement to share information with third parties. It is possible that physicians using MCC websites do not appreciate the full extent of MCC-industry financial ties or are aware of data sharing practices.”

“Physicians who interact with MCCs should be aware that all require personal data from the physician and that some share these data with unnamed third parties,” the authors conclude.

In an accompanying editorial, Lisa Schwartz and Steven Woloshin write:

Medical communication companies’ reliance on industry funding highlights the importance of keeping promotion separate from education. All companies will feel unconscious (and perhaps explicit) pressure to present their clients’ products in the best light. Bias can easily occur in the selection and training of speakers, in their presentations, on the websites, and even in test questions.

Despite new efforts aimed to prevent some of the worst abuses of CME, the editorialists discuss persistent concerns:

Continuing medical education that is tainted by promotion is marketing masked as education. It can lead to inappropriate prescribing that can harm patients and waste money. To remove promotion from CME, some have called for eliminating all industry funding.

GlaxoSmithKline Announcement

GlaxoSmithKline made an important announcement that, although not directly related to the JAMA study, touches on many of the same general issues. ProPublica reporter Charles Ornstein writes:

In a major departure from industry practice, GlaxoSmithKline, the sixth-largest global drug maker, announced Tuesday that it will no longer hire doctors to promote its drugs.

The company also will stop tying compensation for sales representatives to the number of prescriptions written for drugs they market. The changes will be made worldwide over the next two years.