Research into practice

The best research in the world is of little use if it isn’t put into practice.
Sometimes the lag between research & practice is simply a matter of slow diffusion of knowledge. Other times, the story is more worrisome.

Case in point: this interesting story, from the Journal Sentinal: UW course for doctors pushed risky therapy

The conclusions were clear: Women who took hormone therapy drugs were at increased risk for breast cancer, heart disease, stroke and blood clots.

The findings were so strong that researchers stopped a clinical trial in 2002, five years early, because it would have been unethical to continue giving the drugs to women.

But that same year, the University of Wisconsin-Madison’s School of Medicine and Public Health began a medical education program for doctors that promoted hormone therapy, touted its benefits and downplayed its risks.

Critics are pulling no punches:

“It is pure, undisguised marketing,” said Anthony Scialli, an adjunct professor of obstetrics and gynecology at Georgetown University’s School of Medicine.

Drug companies are “funneling money through universities for advertising and trying to disguise it as education….”

The University closed the course down one day after questions were posed to the University about the legitimacy of the program. At this point, the University is investigating the course to see if it met the standards of the medical school. I’m hopeful it did not.

The main problem here is obvious . A course for med students funded and run by a drug company, with views that do not reflect the medical community at large and in fact downplay important risks to potential patients, is worrisome at best.

Here are just some of the concerns that this case raises:

1. In terms of academic curriculum planning, it’s clear that in the training of responsible, ethical and balanced health care professionals, we should encourage up-to-date curricula that encourage active and open debate about many kinds of issues alongside an awareness of the ever present involvement of outside influences into medical training and practice. Plenty of clinical issues should be critically critically examined, questioned and debated by medical students. Issues such as the most effective drug for depression or the optimal treatment of atrial fibrillation are both appropriately debatable topics with room for difference of opinion, based on the findings of clinical research. Some things, however, need to be clearly presented and aren’t debatable. For example, it would be unethical to present a course on the treatment of atrial fibrillation without mentioning that Warfarin (used in patients with persistent atrial fibrillation) causes severe bleeding if mismanaged in patients. Furthermore, it would be problematic to present a course on hormone treatment without a discussion of the serious and significant risks to women alongside the potential benefits.

To have a course disguised as learning but really pushing the agenda of a pharmaceutical company, in exchange for revenue for the school, hardly seems worth it, in terms of potential harm to a significant number of future patients.

2. Clinical research is conducted with the goal of aiding future generations of patients by being applied to practice. That means, to put it simply, applying the good along with the bad, i.e. making sure that beneficial findings are accelerated into practice while at the same time, ensuring that negative findings, serious adverse events and newly identified risks become incorporated into standards of care and practice. Standards of care and practice should be the foundation upon which medical and allied health care curricula are based.

3. We talk a lot about the involvement of pharma in medical school training. It’s one thing to have conferences bags with logos on it and lunches paid for by the local drug rep — I’m not saying that is right, but at least the involvement of the company and the overarching agenda are explicit. It’s another thing, altogether, to implicitly embed what seems to be a misplaced and biased agenda of a pharmaceutical company into a medical school curriculum and disguise it as learning about standards of practice.

~ by Nancy Walton on January 30, 2009.

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