An effort to provide greater transparency in the relationships between physicians and the pharmaceutical industry has taken a controversial turn in Canada, where a leading medical society is being criticized for a new report on the topic.
The College of Family Physicians of Canada, which represents more than 35,000 doctors, earlier this month released a report featuring 21 recommendations that address conflicts of interest and continuing medical education, among other things.
The report emerges amid ongoing debate over the extent to which companies unduly influence medical research and practice. The CFPC, which itself does not accept industry funding, portrayed its effort as a forward-looking statement that will evolve in order to bolster trust and transparency among patients.
The “recommendations point the CFPC toward an approach of clear and conscientious management of relationships with (the health care and pharmaceutical industry) in order to advance the College’s mandate without compromising its ethics and values,” the report boasts.
Yet the report was first begun five years ago and completed two years ago but was not released until some critics publicly raised a fuss. A CFPC spokeswoman wrote us that the report was never designed to be released publicly, but “in retrospect, we recognize that we should have posted the report to our web site … We have no concerns with sharing it publicly.”
More than the odd circumstances surrounding its release, critics say the report falls short. For one, they argue the CFPC continues to back some industry-supported continuing medical education. They add that physicians are not required to disclose financial relationships, and the data that is gathered will not be made available to the public.
As critics see it, the report does contain some useful recommendations — such as creating a fund with industry contributions to finance some continuing medical education — but doesn’t go far enough. One drug policy expert, for instance, said that conflicts of interest need to be eliminated, not managed.
“The report is embarrassing,” said Alan Cassels, a drug policy researcher at the University of Victoria. “Finding good quality — unbiased and useful — drug information is like finding a needle in a haystack. And pharma’s information just makes the haystack bigger.”
Over the past several years, drug and device makers have been under pressure to reduce their role in continuing medical education, or CME, which are programs that doctors are often required to attend to maintain their licenses. Critics have complained that companies can use sponsorships to influence programs by arranging for speakers to discuss or emphasize their products.
In the United States, concerns about the financial relationships between industry and physicians sparked a US Senate investigation and, later, prompted the federal government to create the publicly accessible OpenPayments database, which houses payments made by drug and device makers to doctors.
Amid ongoing scrutiny of industry influence, data released last summer showed that companies increased their spending on CME in the US by just 2 percent in 2014. The findings suggested industry spending leveled off in response to sustained controversy over CME funding.
Dr. Jamie Meuser, a CFPC executive director, acknowledged a need to ensure scientific information presented to physicians is of the highest standards. But he told the Canadian Broadcasting Corporation that removing industry funding for CME “would leave a tremendous gap.”
However, he insisted the recommendations are “not the end of the story … It’s a sincere effort by the CFPC to address an important issue in continuing education … Our board is looking at ways to make sure the best quality scientific information” is presented to physicians and, ultimately, to patients.
We asked Canada Rx&D, the pharmaceutical industry trade group, for comment and will update you accordingly.
Asked why the CFPC will not require its members to disclose financial relationships with industry, the spokeswoman wrote that its task force “believed that the spectrum of such input was too broad … It’s an honor system based on the trust we have in our members and our health care system.”
As to why the CFPC will not make any disclosures available to the public, the spokeswoman explained that the CFPC is not a public organization and does not report to the public. “The College is responsible to its members, first and foremost,” she wrote us.
Still, another critic said such positions are not good enough. “If the college is serious about this issue, it needs to show significantly more leadership,” Joel Lexchin, a professor in the School of Health Policy and Management at York University in Toronto, wrote us.