Field Notes

Career moves. A friend with a Ph.D. in neuroscience waxes lyrical about her job. She feels fortunate to be doing work that she believes benefits doctors and patients. But what she considers a dream job would strike many as a nightmare: she turns out industry-sponsored continuing medical education materials.

Med ed was a midcareer move for my friend, who asked that she and her employers not be identified. She started out doing research at a leading medical center in New York but grew weary of the treadmill of grant applications, among other things. When I voice concern about drug company bias in medical education, she has a ready response: You want to talk about bias? Academic research is full of it—only instead of big pharma bending information to boost its bottom line, there are big-ego senior researchers bending interpretations of data to boost their careers.

Point well taken. The pharmaceutical industry is the favorite piñata of journalists, bioethicists, and other crusaders against conflicts of interest. But conflicts of interest come in many forms, financial ones being only the most obvious. This view is in line with the chapter on a related topic—conflicts of interest in biomedical research—in The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, which is targeted for publication early this fall.

My friend knows the dark side of med ed. We worked together briefly in the field (for me, a midcareer detour from journalism) and witnessed ethical breeches: the lack of a firewall between promotional and educational activities; doctors hired as consultants who downplayed the dangerous side effects of opioids at a medical meeting partly supported by an opioid manufacturer.

My friend says that her present employer is more ethical. When she tells drug company clients that they can't make particular claims, she says, "The good clients—the smart ones—listen, and then you feel you have made a difference in making sure that doctors and the public have the most accurate information."

That's encouraging, but I worry about the "bad clients"—the ones who don't want their wings clipped by someone with a Ph.D. I also worry about newly minted Ph.D.s, struggling to pay back their student loans, who can't say no if a client pushes the envelope, or who rationalize that small white lies don't matter. So what if the client wants to say that we need eight hours of sleep at night when the literature says seven to eight hours—something that I encountered at my med ed job? The difference is trivial in scientific terms, but possibly significant in financial terms—extra prescriptions written for a drug to treat insomnia or excessive daytime sleepiness.

Guidelines issued earlier this year from the Association of American Medical Colleges aim to curb the most flagrantly unethical practices in industry sponsored medical education, such as paying doctors to put their names on ghostwritten articles. They also call for external spot-checks of continuing medical education offerings for "inappropriate influence." What is inappropriate influence—do white lies count? The Physician Payments Sunshine Act, which is pending in Congress, would shine a light on industry payments to physicians but not continuing medical education programs.

The piñata's taken some blows lately, but it's still swinging.