Can Pharmaceutical Companies Ethically Sponsor Medical Education?

September 19, 2023 - The pharmaceutical industry plays a pivotal role in healthcare, driving innovation and providing new tools to optimize patient care and management. Despite the many benefits offered by pharmaceutical companies and manufacturers, there is an ever-present ethical gray area.

It is no secret that ethical concerns about drug pricing, treatment marketing, and patent exclusivity have been a constant battle between pharma companies, regulatory agencies, healthcare professionals, and patients. However, one less-known gray area is the role of pharmaceutical sponsorships in provider education.

Earlier this year, at the 2023 World Medical Innovation Forum hosted by Mass General Brigham (MGB) and Bank of America, Robert M. Califf, the commissioner of the United States Food and Drug Administration (FDA), commented on the potential fallacies of pharmaceutical sponsorships in medical education programs.

"This is a very complicated set of issues: Why would there ever be a need for a pharmaceutical or a device company to fund coursework for medical students?” Califf asked. “The healthcare delivery industry is much larger than the medical products industry, and the academic medical centers are strong, lobbying for financial interests of the academic medical center.”

In this article, PharmaNewsIntelligence explores the historical role of pharmaceutical sponsorships in medical education, provides examples of drug company contributions to medical education, and compares the benefits and risks associated with pharmaceutical involvement in educational activities.

How Do Pharmaceutical Companies Sponsor Medical Education?

Pharmaceutical companies sponsor medical education through multiple methods and solutions. While some types of sponsorship are apparent, others are more discreet. The following methods are some examples of pharmaceutical involvement in medical education.

Funding Continuing Medical Education

Historically, pharmaceutical companies have provided commercial support for continuing medical education (CME) programs — also known as continuing professional development in the United Kingdom — by funding postgraduate educational programs for established healthcare professionals. For example, Pfizer, one of the most notable pharmaceutical companies in the world, has an Independent Grants for Learning and Change (IGLC) program that funds CME. Through the IGLC program, Pfizer provided financial support for independent medical education initiatives developed by third-party organizations. These educational opportunities span multiple therapeutic areas, such as oncology and infectious diseases.

In addition to Pfizer’s contributions, Novartis has historically sponsored educational grants and initiatives for multiple sclerosis and other chronic diseases, including heart failure.

Other industry-funded CME efforts include Novartis grants and educational initiatives, Merck CME grants, Johnson and Johnson‘s education initiative sponsorships for surgical education, AstraZeneca CME grants, industry-sponsored diabetes education initiatives by Sanofi, and Gilead Science HIV education programs.

In a 2021 essay published in BMJ, Adriane Fugh-Berman, MD, a professor and educational provider at the Georgetown School of Medicine, argues that CME should be regulated like product promotions.

According to the essay, many studies have found that CME sponsorships with industry funding favor the products developed by industry sponsorships. Fugh-Berman explains that a grand round presentation at the Minneapolis Veteran’s Affairs Medical Center by a pharmaceutical sponsor correlated with triple the prescriptions of the antipsychotic manufactured by the sponsor.

This data, alongside other phenomena, emphasizes the impacts of industry influence on healthcare organizations, clinician decision-making, and prescribing practices.

Guidelines and ethical standards are in place to ensure that CME remains unbiased and focused on improving patient care. Healthcare professionals engaging in CME activities should be aware of these guidelines and potential conflicts of interest.

Despite varying sources of funding, the Accreditation Council for Continuing Medical Education (ACCME) notes that accredited CMEs for medical professions should follow four core standards.

1. Valid content: The first standard enforced by the ACCME is ensuring content is valid, meaning that all CME information should be supported by scientific evidence-based research.
2. Commercial bias and marketing: The ACCME is also responsible for preventing commercial bias and marketing accredited CME programs.
3. Financial relationships: The third standard focuses on identifying, mitigating, and disclosing relevant financial relationships.
4. Commercial support: While not all CME programs use commercial support, those who do are expected to ensure ethical partnerships that do not get in the way of delivering accurate and unbiased medical education.
5. Ancillary activities: The final standard provides guidelines for managing ancillary activities associated with CME.

Sponsoring Seminars, Conferences, and Symposia

In addition to standard or accredited CME programs, pharmaceutical companies may sponsor medical education in other formats, including conferences, seminars, and symposia.

Pharmaceutical companies may sponsor some medical societies that host annual conferences or regular sessions to help fund the program. For example, the American Heart Association (AHA) Scientific Sessions is a notable cardiovascular conference that companies like Pfizer, Novartis, and Amgen have sponsored.

Sponsorships like this are often accompanied by exhibits or talks from pharmaceutical representatives promoting the companies’ relevant medications or therapeutic interventions.

Other conferences and seminars that pharmaceutical companies have funded include the American Diabetes Association Scientific Sessions, the American Association for Cancer Research Annual Meeting, and the American Society of Clinical Oncology Annual Meeting, among others.

Research And Grant Funding

Some pharmaceutical companies also sponsor research grants and other forms of medical discovery. Companies may offer financial support or tools for researchers to conduct studies and manage the expensive costs of preclinical research and clinical trials.

However, there is a significant potential for conflicts or publication bias when companies sponsor these studies. Researchers may be inclined to alter data to favor the pharmaceutical manufacturer’s interests. While this opposes ethical guidelines, monitoring or managing these unconscious biases may be challenging.

Pfizer offers research grants through its Global Health Innovation Grants (GHIG) for researchers focused on addressing major global health issues, including infectious diseases and other public or global health issues. Additionally, Novartis provides financial support to independent investigators and healthcare facilities. Other companies, including Merck, Bristol Myers Squibb, Gilead, Sanofi, AbbVie, AstraZeneca, Eli Lilly, and GSK, may fund various research and grants.

Financially Supporting Medical Journals and Publications

Pharmaceutical companies can also play a significant role in the survival of medical journals and in getting research articles printed. Beyond funding the actual research that is published, pharmaceutical companies may provide financial support and donations to support publication expenditures. Manufacturers may also pay for advertising in medical journals and publications.

While different companies have various standards for industry involvement and the role of sponsorships in publications, ethical standards generally focus on ensuring that all data is scientifically sound and void of biases.

Medical School and Institution Grants

In addition to postgraduate medical education and clinical research support, pharmaceutical companies may sponsor medical schools and provide institutional grants. These grants may be given to medical schools to fund research, educational initiatives, scholarships, fellowships, collaborative researchers, medical devices or equipment, and medical libraries or informational resources.

Weighing the Benefits and Risks

Pharmaceutical sponsorships can play a significant financial role in the prosperity and availability of medical education across multiple levels; however, the associated risks may diminish the potential benefits, compromising scientific integrity, patient care, and disease outcomes. It is essential to understand the balance between the benefits and the risks.

Some of the most apparent benefits of pharmaceutical sponsorships include the following.

• Less expensive education for medical professionals and students: When pharmaceutical companies sponsor seminars, webinars, and CME programs, these programs could be covered or less costly due to the contributions. For many medical professionals who pay fees to keep their licenses up to date or are still paying off medical school tuition, free or less expensive CME could be a significant perk.
• Access to information: In addition to the tools that pharma companies may provide to support medical students and CME students, they may also be able to donate medical textbooks, maintain journals, and introduce other resources for medical students. A wide range of information can become easily accessible through these contributions.
• Research and development: Pharmaceutical companies' investments can significantly contribute to research and development. Research and development costs are astronomical, and medical institutions, especially smaller research centers without federal grants, may rely on pharmaceutical support to fund research and innovation.
• Networking: Pharmaceutical sponsorships may also provide significant networking opportunities for medical professionals. For example, seminars and conferences can be a great place for medical professionals to meet, interact, and collaborate.

On the other hand, there are some significant and potentially detrimental effects of pharmaceutical sponsorships in medical education.

• Conflict of interest: The most glaringly obvious issue with pharmaceutical funding in medical education is the potential conflict of interest. Pharmaceutical companies can compromise the objectivity of institutions, teachers, researchers, and journals by providing financial support.
• Prescribing practices: Beyond bias in the educational training and information release, sponsorships, if done unethically, may impact prescribing practices. Providers who attend regular sessions from one manufacturer that advertises a specific drug may be more likely to prescribe that drug over other available alternatives.
• Lack of transparency: Many issues arise from a lack of transparency about the funding source and how different companies may contribute to educational efforts. Despite more companies moving toward transparent practices, the continuing opacity of the pharmaceutical spaces can be a negative side effect of pharmaceutical sponsorships.
• Overemphasis on pharmaceutical solutions: Although pharmaceutical solutions have revolutionized healthcare and can be the best treatment tool, other medical interventions may provide more beneficial solutions. Pharmaceutical sponsorships will likely push providers toward drug-based treatments even if other interventions could work better.

Overall, it’s unlikely that pharmaceutical sponsorships will ever completely dissipate from medical education. Financial reliance on these sponsors and investors could cause economic repercussions if they were eliminated. However, companies providing subsidies should be conscious of the information they put forward, ensuring that they follow the best ethical practices and standards. Ensuring that all claims are backed by unbiased, scientifically sound, evidence-based data and transparency about sponsorships can position companies well for moral involvement in education.

Moreover, medical professionals and students who accept these sponsorships should be mindful of their interactions with these sponsors and investors. Students and healthcare providers should consider the potential conflicts of interest or bias in the claims presented and look for medically accurate data to support any clinical decisions.