Healthy Skepticism
One who instinctively or habitually doubts or disagrees with assertions or generally accepted conclusions is reasonably termed a skeptic. John Dewey termed scepticism as the mark and even the pose of the educated mind. While writing this item I received an invitation in the mail to join with ANZSGM colleagues in an Educational Symposium with free air travel, five star accommodation and an evening dinner in a leading Sydney hotel. The scientific steering committee, program and contributing faculty prompted appeal and immediate admiration. I was further motivated to attend by the supplied affirmation that the Symposium would adopt the Medicines Australia Code of Conduct in handling the educational grant from the five star pharmaceutical company.
In reflecting on the offer, I recalled my funded attendance at a media training symposium of comparable quality. It had also been sponsored by the pharmaceutical industry and held in a splendid Adelaide venue favoured for marriages and relaxing weekends. One challenge we received from our media trainers was to respond to a theoretical media doorstop challenge to a consultant physician leaving such a luxurious venue when confronted by the press. The theoretical media challenge was along the lines of "you doctors who receive such luxurious stays and dinners are surely going to prescribe the latest expensive new drugs of the sponsoring drug company". I recall the winning doorstop reply captured on the playback training video was something like "as a doctor, I am prepared to travel and stay in a broom cupboard if I could learn something of value in treating my patients!" The media experts looked pleased.
I cannot attend the above symposium but kept the invitation to use the topics as a template for personal Continuing Professional Development. I wish the organisers and attendees success in their educational endeavour.
The Code of Good Medical Practice adopted by our new Medical Board of Australia records many discernable qualities of good practice and one relevant under Section 8 (www.medicalboard.gov.au/en/Codes-and-Guidelines.aspx) directs that we recognize that pharmaceutical marketing influences doctors. The Code requires that we be aware of ways in which our practice may be influenced by such marketing. An Inuit proverb records "gifts make slaves as whips make dogs". When surveyed, doctors as a group curiously declare personal resistance to such marketing influences but declare their colleagues as susceptible and thus more likely to prescribe under a sense of reciprocal obligation after being recipients of industry largesse. Many colleagues would have seen that the Harvard Medical School has recently introduced major policy change for faculty in their interaction with the pharmaceutical industry (http://hms.harvard.edu/public/coi/review/index.html)
A further requirement of our ongoing Medical Registration is the need to reveal evidence of CPD. How can we better adopt such practice directives and thereby indicate to the public that we are "good medical practitioners".
My recent management committee role in Healthy Skepticism, an international body which aims to improve health by countering misleading health information prompts me to offer this CPD resource as a possible solution. Misleading health information harms health and wastes resources (amply revealed in the current class action against the purveyors of the once heavily promoted anti-inflammatory drug Vioxx). The Healthy Skepticism website contains many free accessible resources on quality prescribing information including, criticism of past industry advertisements on rosiglitazone (August 2007), celecoxib (June 2007), venlafaxine (September 2006). Can I therefore recommend that you consider a look at www.healthyskepticism.org.
Lest I be accused of any conflict of interest, I declare none and even offer an alternative but similarly focussed website www.nofreelunch.org and the offered resources for evidence based prescribing and insights into marketing strategies. Healthy Skepticism and this USA industry watchdog group are examining ways of linking their sites to expand their existing international reach.
Like your correspondent Sir William Osler may also have been in graded retirement, when he wrote "the young physician starts life with 20 drugs for one disease and the old physician ends life with one drug for 20 diseases!"
Dr Philip Henschke