MEDICAL CONFERENCES

  MEDICAL  CONFERENCES  --  the Good and the Bad

Dr. T. Rama Pasad

https://drtramaprasad.blogspot.com  

At the outset I must say that this write up is not meant to cause any offence or disrespect to the medical fraternity for whom I have the greatest respect and admiration.  It is merely to put in perspective the varied projections in the public media following the publication of a proposed regulation by the National Medical Commission (NMC) in August 2023 barring doctors to participate in certain medical conferences.  Articles in medical press and general press had appeared on the influence of sponsorship of academic activities by industry on prescription practices, both in India and abroad.

            Le us imagine.  Suddenly an order is passed barring people of a particular profession to attend any wedding reception of a related  professional community.  There is an uproar -- somebody is spending for the event  and the invitees are too willing to participate.  Why should an authority prevent the participation ? 

NO ENTRY to CONFERENCES

            The same is the case with the proposed regulation barring doctors to participate in medical conferences or academic meetings sponsored by pharmaceutical companies and other allied health sector firms.  The regulation also mandated doctors to prescribe by 'generic names' (common names of molecules, not specific 'brand names' given to the molecules by the companies).  

         This 'order' came from the National Medical Commission (NMC)  in August 2023 and made sensational news on public media, and a furore in medical and pharma circles.   The NMC regulation stated that doctors "should not be involved" in any educational activity like seminars and conferences "which involves direct or indirect sponsorships from pharmaceutical companies or the allied health sector."  A doctor's license may be suspended for up to three months for violation of the regulation.  It apparently sounds anti-progressive and anti-educative.  

SIMMERING  ISSUES 

            So, the people started asking :  "Why ?  What's the background ?  Why doctors should not be educated ?  What's the connection between the industry and the medical profession ?"     Previously, the subject was in the professional media.  Now, it has spilled over on to the public domain.  There were high-octane protests by the vested interests which forced the government to  keep the regulation in abeyance.  

            Yes, the medical scenario in India is a very complex one puzzling every one at the helm of the affairs.  Various regulatory measures and developmental programmes were carried out over the past half-a-century in the medical field, but there was no escape from the mosaic of a memory laden with failures and successes.  Some had gone ballistic with the proposed NMC regulation.  Despite keeping the regulation in abeyance, the controversial and contestable subject is still simmering.  

            For politeness-sake, I didn’t want to write on this 'unholy' subject, but facts have already appeared on the  Net.   There is a burgeoning global appetite for money.  The orchestrators of much of the degradation go scot-free.   The restrictions imposed by the erstwhile Medical Council of India (MCI) on receiving of gifts from pharma companies by the doctors remained mostly on paper, and the business had been as usual.  So there's a sense of helplessness which might have given way to the anger of the NMC.  And the anger seems to have given way to acceptance (through keeping the proposed regulations in abeyance) by virtue of the strong protests.   

            There must have been a strong reason for proposing the regulations,  as  the NMC is not made of ordinary people, but of eminent experts.  Curiously, the NMC did not suggest banning of sponsoring activity by the industries, just as the MCI didn't suggest a ban on the companies to give gifts.   The fate of many of the regulations is like that of banning dowry which remained mostly on paper - giver is happy, receiver is happy.  Then, who can stop them !                

CLOSE  LINK

            Though seem to be separate issues, 'sponsorship' and 'generic prescribing' are closely interlinked.  Understandably, both the issues of 'sponsorship' and 'generic prescribing' affect both the manufacturers and the doctors as they are intricately bound.   'Conference activity' generates profits to the companies through prescriptions by their 'brand names' and their promotion by the attending doctors.  And the doctors are benefitted by the academic and educational activities, and also, perhaps, by the hospitality and sponsorships for travel and tourism by the companies.

'ATITHI DEVO BHAVA'

            It's a sort of a host-guest relationship.  One who enjoys the hospitality would like to favour the host.  Of course, there are enticing extra-academic frills to the conferences -- tourist destinations, luxurious travel, five-star hotels, lavish food, gifts, entertainment, sight-seeing, great hospitality, etc.  And,  the expenses are borne mostly by the companies (to be paid, of course, by the patients ultimately, indirectly through hiked prices).  If medicines are to be prescribed by 'generic' names, all this expenditure would be a waste of money for the manufacturers,  and a cause of worry to the doctors about the quality of 'generic' drugs.  

            So, this has become a common cause for both the parties to oppose the regulation by the NMC.  If one goes to the bottom of the 'sponsorships' by the companies, it is primarily an activity of luring the doctors to prescribe their branded products.  Drugs and allied products are not like soaps and toothpastes which can be sold through ads in media.  They are to be sold (even 'pushed') through doctors.  It is in this context that the manufacturers spend crores of rupees on doctors directly or indirectly through medical conferences and other means.

CONTINUING  MEDICAL EDUCATION 

  Medical conferences are of great educative value where knowledge, experience and research findings are shared.  They are sacred gatherings for exchange of notes and views on advanced learning and treatment.  The latest findings in research are put across for debate and analysis. Information is dissipated  which is yet to make an entry into text books.  These are purely academically oriented extensions of medical education,  otherwise called ‘Continuing Medical Education (CME programmes)’. 

This is how they should be, and how they were all, and how some of them are still like that now.  Alas,  the scenario has been changing a tad, in line with everything else in the modern world.

BUSINESS BOSS

 One scientist said: “Industry is stepping in to define how they should be.  Commercial brush is painting attractive colours of its own choice.  Business magnets ‘direct and produce’ conferences, with some researchers and doctors as ‘actors and artists’. There is a perceptible degeneration of the quality of conferences, seminars, workshops, guest lectures, CME programmes and the like into academic and commercial gimmicks.”  Often, the medical conferences are the launchpads for introduction of a new molecule or a branded product to the medical fraternity.  Speakers are selected and the proceedings are scripted often by the 'Big Pharma'.

This is an era of conferences galore for every subject, everywhere and every day.  Nowadays, medical conferences are also  generally conducted on business models, mostly sponsored                                                                                                                                            by industry. 

LURE

        The Senior Consultant & Vice-Chair, critical Care & Emergency Medicine of Sir Gangaram Hospital, New Delhi, cited a couple of studies published in medical journals (JAMA & BMJ) which established that bribing the doctors through gifts, funding for conferences, sponsoring for conference travel / holidaying, etc. did influence prescription practices in favour of the sponsoring pharmaceutical and medical devices industry (April 26, 2016 --    http://blogs.timesofindia.indiatimes.com/toi-edit-page/when-doctors-take-bribes-how-entrenched-conflict-of-interest-in-indian-healthcare-endangers-patients/ ).  

He wrote: “When your doctor prescribes a medicine saying it’s the best for you, are you sure it’s in your best interest, or was he taken on a luxury cruise last summer by the pharmaceutical company which sells that medicine ?”

THEATRICAL 

In a review published in The Guardian of the book BAD  PHARMA by Ben Goldacre, it is mentioned:  “…  Companies pay doctors to extol the virtues of their drugs on the conference circuit (spelling out the sources of information they want doctors to use) …”  (www.theguardian.com/books/2012/oct/17/bad-pharma-ben-goldacre-review ).  This link is a must read.  Go to it to know about the sordid things that happen behind the glossy façade of ‘modern medicine’.  

The show is so perfectly planned, choreographed and executed that even some genuine researchers and doctors do not suspect the ulterior motives.  And the beneficiaries don't expose as "Whose bread you eat, his song you sing."  This 'singing of the song' is rewarded  extremely well and loved by big business barons. 

THANKS TO THE PHARMA

  The pharmaceutical companies sponsor a lot of research activities in developing new drugs and thus helping the mankind.  We should be grateful to the 'Big Pharma'. We shouldn't blame the manufactures, but the vulnerability of the mankind.  Nobody (including many of the hospitals) does business for charity.   And they have their own innovative ways of achieving their goals. But, the values are depreciating exponentially as we speak.   The malaise is deep rooted.  

BITTER  TRUTH  

                In India too, out of vested interests, business houses sponsor ‘academic activities’ with ‘inducements’  like travel, tourism, hospitality, holidaying, gifts, etc., notwithstanding the restrictions imposed by the erstwhile Medical Council of India.    

        The manufacturers cleverly create a veneer of academic atmosphere, but not without the glamorous commercial colour.  Even the name badges hung around the necks of the participants are full of trade names of medicines.  One wonders as to how many would attend the ‘conferences / academic activities’ at their own expense and without the ‘inducements’,  ‘sponsorship’, ‘sightseeing’, ‘gifts’, ‘dinners’, ‘CME credit points’, grand hotels, etc.  Strip the conferences of all this  glamorous outfit,  and conduct them in conference halls of medical colleges, and then have a peep into the conference halls -- they would be almost empty !  Perhaps, this is an exaggerated statement as there are institutions like Tata Memorial Hospital, CMC Hospital, Vellore and The Mahatma Gandhi Institute of Medical Sciences in Sevagram have been organising conferences without pharma sponsorship.  But they are an exception.  Conferences have evolved in such a way over a period of time that the present generation of doctors may sing a dirge to them if not dressed up with the pharma glitz and glamour, and celebrated like melas with banquets and cultural nights !  No amount of spin or gloss can hide the painful truth.

          One said that there are seven points of interest to attend a clinical meeting or a medical conference, the last one being of the least importance though that is the main goal :  1. Gossip  2. Business  3. Entertainment  4. Tourism  5. Trade union type of security  6. Dine & wine  7. Academic programme.

VESTED  INTERESTS

        Medical ethics have taken a back seat. Of course, the sponsoring businessmen or institutions expect the speakers and the sponsored participants to say and do something ‘good’ to promote their products.  Quid pro quo.  There seems to be a tacit agreement while accepting the ‘inducements’ and the 'very costly gifts'.  The subjects and speakers are largely the choice of the manufacturing companies.  It has been alleged that some of the study designs, protocols and presentations are crafted by the manufacturers to pave the way for favourable conclusions.

            The announcement of mandatory requirement by the medical councils to obtain a stipulated quantum of credit points by attending CME academic sessions is another reason why doctors attend the conferences and academic meetings. Read under the heading “MODERN MEDICINE  -- the Good, the Bad and the Ugly” on this blog.

FUN  AND  FROLIC 

In the middle of a scientific session at a national medical conference which I attended, the organisers made an announcement that  buses were ready to take interested delegates for sightseeing.  Hurray! Half of the gathering vanished. The already thin attendance becoming thinner made the speaker speechless! I was a witness to many narrating excitedly about the tourist spots in and around the cities of the conferences – not a word on the academics of the conferences !  Some of the speakers are also in the same boat.  They make worthless presentations and doctored endorsements, and get pampered by the sponsoring industry.  The stereotypic and vapid ‘power-point' presentations evoke no intellectual interaction.  Many speakers do cause a ‘bore’ by drearily dull, drab and repetitive presentations -- through simply reading what is written in the "copy & paste" slides.  

Many think that they can get better and more information of this type through the Internet in a fraction of the time spent on attending such of these meetings. But some do a lot of literature research and incorporate relevant matter (there may be an ocean of irrelevant matter on the Net) on their slides in a nutshell -- original or copied -- and save us a lot of time.   I hasten to add that many speakers make the meetings very lively and beneficial through their original work and rich experience, and their oratorial skills.  But, they are few and far between.  

LIGHTER SIDE
          In many medical meetings,  ‘some participants’ arrive at the ‘right time’ just at the conclusion of the ‘crashing academic bore’ and participate jubilantly in the ‘wine & dine’ activity to their heart’s content !  In the case of some of the smaller events, some sponsors (medical companies) make sure to have a ‘bottom line’ on the invitation card reading “cocktail dinner follows.”  In some mega conferences,  they invite Ministers to inaugurate and film stars to entertain.  Some of the conferences, these days,  are of a drama of a few days with fun and freebies for hundreds with practically nothing achieved academically at the end of the day except gain of credentials for those who presented papers, some of which may be of dubious value .. and 'Certificates of Participation'  are handed over like handbills, sometimes without writing the name of the participant !

PARADIGM  SHIFT

           That said, I hasten to add, to be fair, that many outstanding academicians make excellent contributions to knowledge at various meetings and conferences and scores of delegates are immensely enriched with knowledge. And this would not have been possible without the sponsorship support of business companies,  as money seems to be a crucial factor.  We should thank the 'pharma companies' for facilitating research and education.

                What is of concern now is the paradigm shift with overall dilution of academic excellence and the undue influence and business focussing by vested interests, in recent times.  “Paid research” is another ugly phenomenon which is growing fast.  Sometimes, scientific papers are doctored by manufacturers and presented and published through ‘researchers’. It seems the world, including academics, is running on money.  What seems to be the bane of the system globally is the fact that some in the field have largely shed their “nobleness” and started living in the ‘dog-eat-dog’ world with all the grey economy and vested interests.  The industry is cleverly exploiting this ‘weakness’ through various kinds of 'funding', ‘grants’, ‘support’, ‘sponsorships’ and ‘offers’ – overt and covert. 

         To see something more on the good and bad of the medical profession, read my articles published in The Antiseptic (medical journal) --   Rama Prasad. T., COVID medical literature – the Good, the Bad and the Ugly.  The Antiseptic, 2022 September; Vol. 119; No. 9; P: 07-19; Indexed in IndMED – www.antiseptic.in ; Rama Prasad, T.  The Science and Nonsense around COVID.   The Antiseptic,  2021 November;  Vol. 118;  No. 11;  P: 8-14;  Indexed in IndMED --  www.antiseptic.in  ;  Rama Prasad, T.  Disastrous Second COVID Wave in India.  The Antiseptic.  2021  June; Vol.118; No.6; P: 20-27; Indexed in IndMED – www.antiseptic.in   , Rama Prasad, T.  Over-prevention, Over-investigation, Over-diagnosis and Over-treatment . The Antiseptic. 2023 November; Vol.120; No.11; P: 12-17, and my 'scribblings' titled  'HCQ, Ivermectin, Coronavirus and Frauds', ‘Medicine in Rural India’, 'The Good, the Bad and the Ugly of Modern Medicine' and ‘Run on Money’ ,  on this blog.

August 2023

The following are some of the proposed new regulations of the NATIONAL MEDICAL COMMISSION (NMC) published in August 2023 in media.

         

            Not unexpectedly,  this notification was followed by an avalanche of protests by various organisations, associations and vested interests forcing the authorities to keep the matter in abeyance.   Yes, debates, discussions, deals, legislations and regulations would go on, and finally end in 'BUSINESS AS USUAL' -- just as in the case of dowry or bribery.  Now, in 2023, the NMC, India's top regulatory body for medical education and medical professionals, has attained the coveted 'World Federation for Medical Education (WFME) Recognition Status'.  Does it mean that all the 'approved' medical colleges in India meet the highest international standards of education and training, and align them with the global best practices and benchmarks ?  Yes, on the paper at least !

            In an article in the British Medical Journal, Dr. Kamran Abbasi and Dr. Richard Smith wrote : "Doctors and drug companies must work together, but doctors do not need to be banqueted,  transported in luxury, put up in the best hotels, and educated by drug companies. ... How did we reach the point where doctors expect their information, research, education, professional organisations, and attendance at conferences to be underwritten by drug companies ?"  This sums up the problem and the solution too.  And now, putting the new regulations on hold by the NMC sums up the strength of the 'pharma-doc' relationship --  call it 'brotherly' if you want to be nice, or 'nexus' if you want to be rude.  Money and material seem to be important in any relationship these days !

The NMC seems to subterfuge for dismantling this relationship, but the pernicious influences of the deep-trenched systems make it hard to navigate through.  And, no amount of spin or gloss can hide the truth.

Health of the citizen (Special article)  -  The Hindu,  Vol.99 A, No.198,  p.8,  1976  --  this 'special' article was written by me and published in The Hindu about half-a-century ago on the 'good-old-subject' of prescribing drugs by generic names.  Periodically some 'babu', 'neta', or somebody exhumes the 'body' of this subject and kicks up some dust, only to be put into the grave once again. 

CONFERENCE:  An event where everybody talks, nobody listens;  and the confusion     of someone is multiplied by the number of delegates !!!

THIS  IS  AN  ABRIDGED  TEXT  OF  MY  ‘SCRIBBLING’.      CLICK  HERE  TO  SEE  THE  FULL  TEXT.   --  T. Rama Prasad