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Should drug industry staff teach students?

As therapeutics departments in medical schools close, Rebecca Coombes hears how the drug industry saw an opportunity

Drug company staff are providing direct teaching to UK undergraduate medical students, a model that the industry hopes can be developed to forge valuable links with trainee doctors. The move comes as many medical schools are moving investment away from clinical pharmacology to concentrate on research.

Pfizer has a contract to deliver a module to undergraduates at Brighton and Sussex Medical School, a new school that does not have a clinical pharmacology department. Pfizer does not charge for its services, and students travel to the company’s headquarters in Walton Oaks, Surrey, for a series of seminars with staff.

More receptive to industry

The Association of the British Pharmaceutical Industry (ABPI) is also delivering talks to undergraduates at several medical schools. Richard Tiner, its medical director. He believes that UK medical academics were becoming more receptive to offers of help from the industry.

“Three to four years ago we weren’t doing anything like this. Last month we had two such talks in a week,” he said. “Clinical pharmacology teaching is diminishing in medical schools—many don’t have clinical pharmacologists on the staff. There is a realisation that industry has expertise in certain areas that may not be available in all of the medical schools in the UK.”

Pfizer says that its experience with Brighton and Sussex has been successful. Joanna Hahn, a medical manager at the company, who runs the course, said it was a student selected component that runs half a day a week over two months. The module is ungraded, although students need to pass it to get their overall degree. The course covers topics from drug discovery through to marketing.

The company’s external affairs staff also address students on its “stakeholder strategy,” which includes relationships with patients’ groups. Ms Hahn said the sessions with students were very interactive and that she was sensitive to the need to be objective.

Not promotional

“It is not promotional in any way, shape, or form,” she said. “When students first started coming here I made sure drinks were available and sometimes lunch. But I stopped that because it reinforced the perception of free lunches.

“We are not trying to hide anything. If anything comes up in the news we discuss it [and] find the right people to speak about it.” Brighton and Sussex offered Pfizer £500 (€510; $720) to deliver the course, but the company declined the fee.

Ms Hahn said, “The main thing we get out of this is the opportunity to interact with the junior doctors of tomorrow. We get to see how we are perceived in the outside world and to give some information. Students are a little bit sceptical at first. But we have good quality conversations. Initially we had students coming through saying, ‘You aren’t doing enough in developing countries.’ The latest lot of students have said, ‘We want to make our own minds up.’”

Martin Kendall, senior medical adviser to the British National Formulary and emeritus professor, clinical pharmacology, at the University of Birmingham, said it was “a major indictment” that many medical schools no longer had a proper department of therapeutics. He was not surprised to see companies such as Pfizer moving in to fill the gap.

It is worth remembering that 6.5% of patients admitted to hospital have adverse reactions to drugs. It is not just the newer medical schools, but the older ones too, who have no identified department of therapeutics. This is actually serious, a major indictment.

“Medical schools are competing in terms of research output and are judged by the amount of money they raise for research and whether they are published in high quality journals. If you were a dean and want to be successful, what you need to do is build up research and reduce subjects such as psychiatry, elderly care, and therapeutics.

“If it means that Pfizer develops a module to teach medical students, that’s not necessarily a bad thing. No doubt people in the drug industry will have expertise and the potential to teach students about aspects of drug development.”

Maintaining objectivity

However, Professor Kendall was concerned about the difficulties of maintaining objectivity in teaching. If a company was giving a lecture on the management of angina, he said, there would be a clear risk of giving preference to their own drugs.

“I’d say it is OK as long as it is properly monitored,” he said. “If a module is put on by Pfizer, for example, it does need to be monitored by an external examiner or by, for example, the clinical committee of the British Pharmacological Society.”

“If the industry does a good job then the medical student will look on that company as a friend. It’s not active marketing but building up a reputation as coherent scientists.”

Richard Tiner of the APBI said that any teaching offered by companies was governed by the industry’s own code of practice.

“This teaching is coming from medics working in the pharmaceutical industry. Anything we do is covered by the ABPI code of practice. We are not able to promote specific medicines. These are general talks rather than about specific medicines. Usually there is a member of [faculty] staff present.”

First published in the BMJ (2009;338:a3179).

See a selection of rapid responses to this article at http://student.bmj.com/issues/09/03/news/86.php.

Rebecca Coombes associate editor London
Student BMJ 2009;17:84 | March

Drug company teaching: summary of responses

How did bmj.com users respond to the news that Pfizer is directly teaching UK medical students? Let us know what you think at student.bmj.com

A worrying development

I hope that the students involved are intelligent enough to take the information given by the drug companies with the proverbial pinch of salt. Unfortunately, this may leave them lacking in basic knowledge and unclear about what information is impartial and what has a bias. Such ambiguity can serve only to make their first few months at work even more frightening and confusing than they already are.

Alexandra J Obee, foundation year 1 doctor in colorectal surgery, University of Birmingham NHS Foundation Trust, Birmingham B29 6JD

Competing interests: None declared.

Degradation of student teaching

Surely the most suitable people to train medical students in this task are those with direct experience of it: other doctors and clinical pharmacists.

Although Ms Hahn claims that the course offered by Pfizer is “not promotional” it is almost impossible for it to be free from bias. The very fact that it is delivered away from the medical school, at Pfizer’s headquarters will influence students. Those delivering the teaching all have vested interests in promoting the company’s products and are unlikely to give equal “air time” to drugs produced by other companies that perform the same function. There are clear benefits to the company and few for the students, who are taken even further from the patient’s bedside than the medical school lecture theatre, further separating theory and practice.

Amy L Blake, foundation year 2 public health, Warwick Medical School, Coventry CV4 7AL

Competing interests: None declared.

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Sublime to the ridiculous

I was lucky enough to be taught therapeutics by Professor Martin Kendall, senior advisor to the British National Formulary, as a medical student and remember him advising us on how to respond when meeting drug reps as qualified doctors. He counselled that we accept the pen, return the smile, and ignore the information.

Charles W Dixon, consultant psychiatrist, Wonford House Hospital, Exeter EX2 5AF

Competing interests: None declared.

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A lesson in objectivity

In the United States, eight universities have chosen to ban any interaction between pharmaceutical companies and their students.¹ This comes in response to this obvious conflict and the evidence that questions the validity of pharmaceutical marketing information.² Why is it then that we in the United Kingdom have chosen an entirely opposite direction?

Patrick James Howlett, medical student, University of Bristol

Competing interests: None declared.

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Striking the balance

Drug development currently does not reflect the global burden of disease.³ Industry’s links with patient groups can have their questionable side.⁴ And drug marketing can negatively influence prescribing.²

Industry and the medical profession share the blame for such problems and industry’s current contribution to improving health and saving lives should not be undervalued. Balanced, objective teaching is vital if we want students to uphold critical, evidence based practise and maintain their patient’s trust. Better models of how to deliver teaching exist: they should be used.⁵

David A Biles, final year medical student, University of Bristol Medical School, Bristol BS2 8DZ

Competing interests: None declared.

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Let us protest loudly

A growing literature suggests contact between healthcare providers and pharmaceutical companies leads to irrational prescribing^{2 6} and to the provision of biased or inaccurate information,^{7 8} with inaccuracies favouring the products of the company.^{7 8}

If we know that most doctors fail to spot misinformation provided by pharmaceutical company employees,^{7 8} can we expect medical students to fare any better?

If budgets do not allow for independent academics and clinicians to give comprehensive teaching in pharmacology then let us protest loudly rather than resorting to unacceptable alternatives.

Tom Yates, final year medical student, University College London Medical School, London WC1E 6BT; Gordon Stewart, professor of experimental medicine, University College London; John S Yudkin, emeritus professor of medicine, University College London; John Yates, emeritus professor of medical genetics, University of Cambridge; Sir Alexander Macara, chairman of council, BMA, 1993-1998

Competing interests: All the authors are or have been medical students. Some teach or have taught medical students.

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A different perspective

I am concerned that medical students are getting this kind of exposure at my university, but I don’t feel that it is to the extent suggested in the article. A maximum of 10 students a year can undertake the module for one afternoon a week over a period of eight weeks in the third year.

It is unlikely that Brighton and Sussex Medical School is “filling the therapeutics void” with this module. The school does not have its own clinical pharmacology department, and although some students think that this aspect of teaching could be increased, all our pharmacology teaching is provided by the school of pharmacy at Brighton University, as part of a series of lectures given in the third year.

However, I am grateful that the article has raised the matter because I think it is one that needs to be monitored closely. Guidelines exist with regards to interactions between doctors and large drug companies in this country, but too often medical students, who may often be more impressionable, are overlooked in this area.

Raphael Rogans-Watson, fourth year medical student, Brighton and Sussex Medical School

Competing interests: I am a fourth year student at Brighton and Sussex Medical School. I have not taken the student selected component in question.

See “Should drug industry staff teach students?” http://student.bmj.com/issues/09/03/news/84.php.

Student BMJ 2009;17:85 | March

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1. www.amsascorecard.org
2. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373-80.
3. O’Neale Roach J. Research does not reflect global disease burden. BMJ 2000;320;1228.
4. Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002;324:886-91.
5. Black H. Dealing with drugs. Lancet 2006;364:1655-6.
6. Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CAMJ 1993;149:1401-7.
7. Lexchin J. What information do physicians receive from pharmaceutical representatives? Can Fam Physician 1997;43:941-5.
8. Ziegler MG, Lew P, Singer BC. The accuracy of drug information from pharmaceutical sales representatives. JAMA 1995;273:1296-8.

   

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