Medical education: a hearts and minds operation

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Modern medicine has a smorgasbord of problems that need immediate attention for the sake of public health. On the priority list, the topic of medical education takes first place.

Training and education for medical doctors of all levels are at a critical juncture, the vast majority of it being directly or indirectly funded by the pharmaceutical industry. While pharma-sponsored education and drug representative visits were happening as far back as the 70s, the tide appears to have shifted with the introduction of CME for doctors (Continuing Medical Education). The ‘steering’ of medical education and its global control began at this critical time in history.

Educational activities and related medical programs for doctors are mostly privately funded, requiring significant resources that are limited to the deep pockets of large corporations and multinational companies (like pharmaceuticals) that have a vested interest in the profession. Many doctors state they do not recollect catching even a whiff of a drug salesperson or seeing any medical advertising whatsoever during their medical school days. I agree. Unlike today where healthcare equates to business, traditional medicine was untainted, fresh through every season, transparent and pristine.

William Osler, a Canadian physician, was wise when he said, ‘The successful teacher is no longer at a height, pumping knowledge at high pressure into passive receptacles.’ When searching for the source of medical education for modern-day doctors these days, it seems to be getting out of reach, trickling from higher and higher up above, with the tracks leading up to the pharmaceutical industry. All roads do seem to be leading to Rome.

I recently found a flyer in my mailbox amongst many such inconspicuous articles and materials and was quite intrigued by the overt statements of goodwill for doctor’s education by the industry.

This first edition of GP Digest sounds like an exciting educational venture for doctors, much like a fancy toy to explore in a toddler’s hands. Giving them the benefit of the doubt on their goodwill, the ‘well-intentioned’ pharmaceutical company appears very interested in the education of current (and future) doctors.

A flurry of questions come to mind with the flyer. Do these private entities take an equal interest in the betterment of a surgeon’s or an obstetrician’s medical education? Does it have anything to do with prescribing drugs? Why give the doctor drug samples to test out on their patients and why not give it to the pharmacist instead to provide to the patient? Are these drugs on-patent or off-patent?

The flyer above appears to be promoting a pill for an ill practice, or is it just me getting the wrong idea? With this profit-centred industry steering doctors on their prescribing habits (and shaping their knowledge and thinking in the process), is the sacrosanct practice of medicine being dragged down from its once revered and honoured pedestal?

On August 10, 2023, Netflix released a series titled Painkillers which is based on the story of Purdue Pharmaceuticals which, starting 1952, is alleged by the series to have potentially played a role in creating the now monstrous global opioid crisis. The series illustrates the foul plays of marketing the ‘safe and effective’ drug Oxycontin (still sold in Australia), an opiate analgesic medication whose equivalent on the street is cocaine.

This must-watch series is an eye-opener for the lay public as it exposes the decades-old playbook used repeatedly by pharmaceutical companies who are allegedly willing to do all sorts of things in pursuit of profit. In this day and age of mis, dis- and mal-information, the series could be branded as any of these and risks being removed from the platform for breaching community standards and spreading ‘harmful’ information.

I like using real-life examples when I describe a problem and this is one I cannot ever forget. In the year 2018, I was at a doctor’s conference in India where I met up with a doctor colleague who works as an executive for a top pharma giant. Following a presentation I gave on scientific fraud and corruption in research, I was approached by a colleague at the post-event dinner and applauded for what he genuinely believed to be a great talk.

Wary of any such cosy industry associations, and with scepticism, I asked him why a person in his position would applaud me talking against the industry. He quietly confided in me a story that caused chills in my bones. In that year, his employer had received authorisation to release a biologic (a class of medications for autoimmune disorders). Before this, during the trial phase, he was directly responsible for the post-marketing surveillance for adverse effects across the Asia-Pacific region. He became emotionally distraught as he described the serious reports of harm and even a few deaths that were being reported which he dutifully compiled for immediate presentation to his seniors for the next team meeting.

When he thought he was doing his job justice by presenting facts, he was aghast to be met with false reassurances and a stern warning to keep it to himself. He never heard back from higher up and the drug received full marketing authorisation without batting any eyelashes. This is the ugly game the medical profession is being dragged into and the rules of engagement are not on its terms. Alas, the unsuspecting public.

Today’s doctors receive very little to no training in nutrition and lifestyle medicine in their basic or advanced medical training. A serious question to be asked of medical practitioners is, ‘Should we approach the current chronic disease pandemic firstly through lifestyle interventions, incorporating dietary and nutritional strategies for the patient, and educating the public (and doctors) about how invaluable these approaches are in modern day illnesses?’ To this we may add, could daily sunshine and managing stress help improve blood pressure and other cardiovascular diseases that seem to be the plague of the century? As to why it is skewed towards prescribing and not in their learning modules or mentioned in the journals or the drug rep flyers begs concern.

These days, it is impossible for doctors to flip through a single medical journal without seeing a flurry of marketed pharmaceutical products. The repeated visualisation ingrains and trains the brain to remember the drug and reach for the prescription pad during patient visits. It’s a simple oft repeated ploy of marketing; seeing is believing and the more often you see it, the more likely you are to remember it and less of it you see, the more likely it is to be shoved into the attic. These are strategic brain training drills, lest we forget.

As part of the charade, drug rep-sponsored free dinners, lunches, and similar enticements are used to motivate doctors who would otherwise decline attendance.

Doctors are generally time-poor and unfortunately unlikely to be reading very many articles, let alone doing research, unknowingly becoming victims of this fishing expedition.

A fair share of these ‘educational meetings’ are psychological rendezvous taking place in broad daylight. To add, clinicians depend heavily on these events and journals for ongoing education, the former also offering the ease of mandatory CPD (Continuing Professional Development) points to maintain their medical registrations. What better way to kill two birds?

While all of this appears to be benign and harmless, it has been and continues to be a well-orchestrated hearts and minds operation with profits, not health, as the reward. While creating health and wellness would be ideal, curing people of disease wouldn’t be a good business model for this industry.

It is my opinion that the marketing of health in the name of medical education should be considered a criminal offence and is antithetical to creating wellness. While the former is a monetary transaction, the latter is a journey that begins in the womb and ends at the tomb.

Has ‘science’ become trademarked, and could it ever be trusted by the medical profession as being the backbone of the practice of medicine? Will the doctors of the world stand together to say enough is enough and we will take no more of this BS? Will our governments and health experts ever realise that they may be getting shafted and hoodwinked and what is being presented to them in the name of science could be nothing but trickery?

Mark Twain was quite persuasive in his 1906 autobiography where he wrote: ‘The glory which is built upon a lie soon becomes a most unpleasant incumbrance. How easy it is to make people believe a lie and how hard it is to undo that work again.’

I rest my case.

This article first appeared in The Spectator Australia here.

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