Pharmacy

In the world of mixed identities and subsequent ambiguities, the essence of a noble concept like Continuing Medical Education (CME) by pharma companies seems diluted. In doubt is the intention 'is it crystal clear'/ ie, imparting up to-date medical education such that the professionals can keep themselves abreast with the growth in market, or 'is it one of the innovative and strategic tools for marketing'? Experts share their views and opinions.

 Chandreyee Bhaumik

 Knowledge without justice ought to be called cunning rather than wisdom. –Pato When pharma companies are organizing CME programmes, several in the industry are observing this action as a cunning move rather than one meant for mere knowledge-imparting purpose. By definition, CME refers to a specific form of Continuing Education (CE) that helps those in the medical field to maintain competence and learn about new & developing areas of their field. These activities may take place as live events, written publications, online programmes, audio, video or other electronic media.

However, under the guise of CME, hefty gifts like laptops, overseas trips and many others are provided. Thus, the question that quite commonly surfaces is: Has CME become a charade? Is it another strategic tool of marketing? Thus, the once symbiotic relationship between the medical professionals and pharma companies appears to be dwindling.

With growing demand for a more meaningful involvement of physicians to provide clinical support to patients, an imminent need is felt by the medical education providers for insights on drug information and current status of therapeutics available. Physicians usually incorporate a drug in their practice through the knowledge gained during conferences, seminars and the literature supplied by pharma companies. They seldom have time and inclination to assess the current published drug literature covering aspects like adverse drug reactions and interactions. Participation of pharma companies in medical education would focus on merits and limitations of multitude of products available in the market and thereby help in the evaluation, selection and utilization of drug products. However, the recipient must decide on his own to promote rational drug use. Rapid advances in medical science increase pressures on physicians to stay up-to-date in their field. Again, it must be remembered that cost of medical education is rising and funding sources are scarce and therefore in such a situation medical education-providers are turning to pharma industry for assistance. A well-informed physician would ultimately benefit the patient through latest therapeutic advances.

Patients with their life at stake, depose their trust and full faith in the practicing physician. However, one can say that this ethical controversy comprising medical practice and pharma industry has been exaggerated;   Hence, the information supported by the pharma industry has to be objective and rational.   

Dr Amita Bajaj

Professor of Pharmaceutics &Director-Center for

CURIE-DST, SNDT Women’s University

The pharma industry and the medical professionals share a very healthy symbiotic relationship. Hence, it is not incorrect to say that the effort of the pharma industry to support educational conferences is indeed fruitful.

Everything has its own pros and cons. The medical professionals need to have regular updates about the current state-of-the-art treatment protocols, which are discussed in annual monthly national or regional meets. Further, these meets are arranged with educational grants from pharma industry. Again, the industry in turn gets updated with the latest trends in practice along with the prescribing protocols so that in this way they are able to fine tune their marketing and sales techniques.

 Further, the trend of having 'best Of the international conferences summarized can be of great input to doctors who did not attend the meets and also the industry to look at the trends and possibility of utilizing such protocols in the

Indian scenario.

Again, the practice of getting international speakers to share their respective experiences is beneficial to everyone. It can be said that all these are all possible with educational grants.

However, misuse of this aspect with multiple meetings by different companies intending on promoting their products render no educational benefit at all.

Dr. Dhairyasheel N Savant

Consultant Cancer, Reconstructive surgeon, SL Rageja

(a Fortis associate ) Hostpital

When anyone is discussing this, one tends to blast pharma companies for their 'unethical' ways of coercion towards prescribing their products. One is usually found to term them as the plague that has turned the 'noble' medical profession into 'business'.

In India, there is no direct way of patient marketing except for Over-The-Counter (OTC) brands. Pharma companies have to reach out to their customers through the doctors. Thus, the companies would like to do all promotional activities. But why do they have to do that? There are several pharma companies with infinite products. Therefore, there is too much choice for the customer. Thus, in this scenario, strong promotional activity is required to maintain the sales of the company.

Again, India never had a CME credit culture in the past, but this scenario has changed a lot. Medical Council of India (MCI) now requires mandatory CME credit points for renewal of the medical licence. Further, MCI has also laid down guidelines as to which CME activity will be eligible for CME credits. Thus, more doctors now want to attend and conduct CMEs. Again, it can be said that CME is sometimes used as a marketing tool rather than an educational tool these days. Newcomers in practice prefer to be the speakers at CMEs so that they can get introduced to the doctors in the healthcare arena.

Thus, there is definitely a need for self-discipline, self-regulations and governance. If the fraternity puts a united resolve to attend such activities in the absence of lavish venues/food/drinks, the actual pharma pressure on them would be released automatically  

 Dr. Mandar Kubal

Consultant Infectious Diseases and HIV Aids,

Infectious Diseases and pulmonary Care (IDPC)

Exposure to CME is almost mandatory for physicians. Further, research-based pharma companies in turn are involved both in sponsoring research as well as in providing a channel for spreading the available information. Thus, the relationship between the pharma industry and the practicing physician though viewed with great scrutiny in recent times is in fact symbiotic. At sanofi-aventis, it is our constant endeavour to structure CMEs in conjunction with the needs of the physicians and offer unbiased information. Topics of interest are sought from physicians themselves. Again, post-CME, feedback is also collected from them. For instance, in the area of oncology through our 'Pink Poll' initiative, consensus on the best treatment of breast cancer patients among key opinion leaders is derived. Another example is 'Prayas', a programme that focusses on empowering doctors in rural India with the latest developments and updates in medicine.  These workshops involve doctors sharing updated medical information along with practical insights. Further, these two programmes do not have any product branding, be it in terms of their content (presentations) or at the locations (venues).

However, when incorrect or skewed data is used, CME programmes' credibility is affected. Companies and doctors must be mindful of local [Organization of Pharmaceutical Producers of India (OPPI), Medical Council of India (MCI)] and international regulations [The International Federation   of   Pharmaceutical   Manufacturers   and Associations (IFPMA)] as well the company's    ethical    guidelines    while    conducting such programmes.      

Dr. Muruga Vadivale

Senior Director, Medical and Regulatory Affairs,

Sanofi-aventis Group - India

It is a matter of great concern that has attracted great attention recently from all walks of life. The pharma industry's image is tarnished by supporting medical education due to it’s so called 'inherent bias for physicians’ education.

As a social cause, we would support the fact that as in case of other segments, healthcare segment is also to be updated as if the 'health of the nation'. It is worthwhile to note that our physicians after getting through the prescribed course of their study, start their practice/profession and later 'translating knowledge into practice' & 'keeping-up-to-date on new requirements, treatments, and procedures' in their field is very difficult to acquire. In such a situation, high quality medical education such as pharmacy, imparted by pharmaceutical industry bridges the gap by way of providing value support to the healthcare providers especially the physicians with current updates in their field.

Again, one should appreciate the fact that it is obviously not harmful or unethical to provide funding support for CME, the pharma industry gets public recognition and advertising and in-turn benefits the healthcare providers and patients.

Further, the pharmacists' role in healthcare, especially in the emergence of new diseases, cannot be ruled out, where the physicians can diagnose the anatomy of the patient. However, the therapeutic areas and disease prevention is most important. In such a situation, the industry can shift its focus from brands to therapeutic areas and disease prevention; they could help healthcare providers better diagnose and treat patients from a holistic perspective.

Here the notable advantage is that by providing medical \education/CME, the industry can address issues such as clinical practice guidelines and patient adherence and in-turn better health outcome from greater and more consistent product usage.

The so called 'benefit or undue influence' is merely a matter of integrity of the persons involved in the process. In every field we can see corruption, which does not mean that all involved are corrupt. In public sector, we get quality services provided without any bias or getting undue influences. Ultimately, our motto should be to get the patients benefited when physicians are well-informed about latest therapeutic advances, by staying up-to-date on the advancements in their field.

Wherever the new drugs are part of the general advance in therapeutics, patients will be best served when their physicians know as much as possible about these drugs as soon as possible. The ethical concern is that professionals ought to aspire to trustworthiness - to conduct themselves in such a manner that the public would feel that the high level of trust that they bestow on the professional is fully justified. Exactly how far physicians must go in putting all other interests in order to serve the patient might be debated.

Thus, it is not wrong to have an expectation that the physicians of scientific attainment and good character should rise above the conflicts of ethical issues – and therefore serve the patients well.

Thus, in a rapidly advancing field like medicine, ongoing continuing education is a    professional necessity however definitely, with consistent professional integrity.                

NR Munjal

President India Drug Manufactures’ Association (IDMA)

Vice Chairman &MD, Ind Swift Group, and Vice Chairman,

Pharmaceuticals Exports Promotion Council (Pharmexcil)

This is a raging topic for debate whether pharma industry financially supporting the medical education is beneficial or it is actually undue influence. In fact, this is also a topic of discussion in the US. Medical education in India is primarily trust based. However, unfortunately, even in this situation people are trying to take advantage and therefore sometimes manipulating several factors. Thus, the structure of the trust, how the fund in the trust is coming is a significant consideration. The Indian pharma market is primarily generics driven. And, it is only very recently that the market is going towards innovation. In this situation, sponsoring medical education is more of help. Thus, in this scenario, sponsoring medical education cannot have direct influence on prescription writing.

In the US context, the scenario is different. In the US market, where there is a high presence of innovation-oriented drugs, influence is possible to. Some extent. However, in India, where the medical education requires a lot of financial support, pharma companies extending help is beneficial rather than an influence. In this situation, one may say that in order to maintain transparency, the corporate positioning structure must be clearly defined like who are on the board, what is the source of the fund and many other such aspects. Therefore, from the fundamental level only, the MCI guidelines and many such regulations should have enough clarity.    Thus, broadly speaking, pharma companies   offering medical education do not have direct influence.                              

Vikram  gupta

Founder and managing director, ivycap ventures advison

Pvt. Ltd