The February 23, 2011 seminar was presented by Jerry Avorn, Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital. Professor Avorn presented on conflicts of interest in medical care, education, and research. He opened the seminar by discussing how marketing and detailing by pharmaceutical companies adversely affects our healthcare system. He talked about the transmission of medical knowledge, and described how the practice of prescribing drugs is not necessarily shaped by the science learned in medical school, but rather through detailing by pharmaceutical companies. He went on to note that our current approach in medicine is to assume that more science and more technology are always better, but that such an approach is at odds with having an affordable health care system. People rarely question whether it's possible to have too much science or too much technology. This is of concern because most academic medical centers are largely funded by the delivery of expensive, high-tech medicine, meaning that this approach is not only practiced by current physicians, but is being modeled for future physicians as well.
Seminar participants raised a number of questions about the pressures that influence the ways that physicians make decisions about what kind of treatment they deliver. One of the main issues seems to be that most doctors at academic institutions are responsible for raising their salaries through research and clinical practice. Therefore, there is a strong incentive to provide treatment that requires the use of expensive tests and equipment. Other participants raised questions about the issue of continuing education for physicians. In the current system, that role is often filled by pharmaceutical companies, which has helped to maintain a belief that doctors should not have to pay for their own continuing education. However, it was pointed out that the perceived savings in having physicians receive their continuing education for "free", is far outweighed by the costs of the resulting prescribing habits. Physicians prescribe more than is necessary because they are influenced by the pharmaceutical companies.
However, some participants questioned whether a movement towards a cost-effectiveness model would be acceptable to the public, given that it is usually seen in opposition to an "effectiveness" model. They questioned whether academic detailers would be inclined to convey information about treatments that were more expensive, but also more effective. Others responded to this critique by noting that there would be an immense savings even if we could just eliminate the drugs that are higher cost with no added benefit from physicians' prescribing habits.
Participants also discussed the education of medical students, and to what extent it was reasonable to think that eliminating contact with pharmaceutical companies during medical school would alleviate the problem. There were concerns that lack of exposure during medical school would make students more likely to fall victim to the influence of pharmaceutical companies after medical school. Suggestions included teaching students how to weigh arguments and confront an interested party, and to emphasize the extent to which even medical students are subject to biases.