Pharma goes to the laundry: Public relations and the business of medical education.

What's the difference between medical education and pharmaceutical public relations? Not much, according to the people who do it. "(T)he broad distinction between healthcare PR and medical education is becoming obsolete, writes Neil Kendle, chief executive officer of Lowe Fusion Healthcare, in a recent issue of Pharmaceutical Marketing magazine. So slender is the difference between education and PR than that Kendle cannot even say for certain which business he is in. "Sometimes I describe Lowe Fusion as a 'PR consultancy', sometimes as a 'healthcare communications agency'. Sometimes I just cop out and list the things we do." (1) Here's how the business works. The pharmaceutical industry puts up the money, usually in the form of an "unrestricted educational grant." The grant goes to a for-profit medical education and/or communications company (MECC), which, in consultation with its pharma sponsor, puts together an "educational program." (2) The company and the MECC recruit academic physicians to deliver the program in return for a small cut of the grant. If the MECC is accredited by the Accreditation Council for Continuing Medical Education, it can offer the educational program on its own. If not, it must go through the CME office of a medical school, which--again for a cut of the grant--accredits the program and certifies it free of commercial bias. Then doctors, nurses and other health care workers attend the "educational program" that pharma has funded in order to satisfy the CME requirements of their professional organizations. It is, as the corporate manuals like to say, a win-win situation. The doctors and nurses get CME credits; universities get a new revenue stream; academic physicians get some extra pocket money; MECCs get a lucrative market niche (over a billion dollars a year, according to The Lancet), and the pharmaceutical industry gets to shape the minds of medical America. (3) By laundering its message through the MECCS, pharma gives up some control, but the pay-off is even better: advertisements with the appearance of objectivity. PR practitioners call this a "third-party" strategy. As Kendle puts it, "Third party sources of information, as long as they are perceived to have expertise in the area they are talking about, are much more credible sources of information than the pharmaceutical company itself." Pharma now funds over 60 percent of continuing medical education in the United States. (4) Not bothered that your doctor's education comes from pharma? Have a look, then, at the "communications" arm of this lucrative business. Here the results are scientific articles, often in peer-reviewed medical journals. The money is laundered in much the same way. Pharma pays the MECC; the MECC puts together the articles; academic physicians are paid to sign onto the articles, and the MECC places the articles in medical journals. Some academics simply sign ghostwritten articles, while others work from a draft supplied by the company. Sticklers for honesty merely take the money and write the articles themselves. Fees vary. Some academics have signed on for as little as $1,000 or $1,500 per article, including-the two faculty members at the Medical University of South Carolina who recently "authored" a ghostwritten article on Ritalin for Novartis. (5) Others command much higher fees. When the debate over second-hand smoke was heating up in the early 1990s, the tobacco industry paid a biostatistician $10,000 to write a single letter to the Journal of the American Medical Association. (6) Warner Lambert, the maker of Neurontin, a seizure drug, gave a professor at the University of Minnesota over $300,000 to write a textbook on epilepsy. (7) None of this is exactly new. What is new is the magnitude of the phenomenon, which has only become evident through recent litigation. For years, nobody really knew how much of the medical literature was ghostwritten, or even how much had originated from pharma. …