Dr. Sanwar Agarwal's absorbing and thought provoking article(1) reveals his rage at the dubious marketing practices of a few drug companies. However} we should realize that their hold over our continuing medical education activities is facilitated by our own greed.

Doctors have a responsibility towards their patients-of providing the best medical care possible. It is imperative for us to constantly renew and update our know- ledge, and improve our skills. Continuing medical education is arranged by various associations to fulfil these aims.

Pharmaceutical firms have a responsibility towards their owners and shareholders-of making the maximum profit possible.

Once we understand this difference in the aims of the two types of bodies, it will become abundantly clear how absurd it is for medical societies to collaborate with pharmaceutical firms for arranging continuing medical education programs. While the medical association would like to give its members unbiased, factual knowledge and promote rational practice, the pharmaceutical firm would like to promote its products and get its money's worth.

Pharmaceutical firms are not in the business of continuing medical education, catering or gift giving. When they disburse sumptuous meals and extravagant gifts, it is not out of altruistic impulses. When they spend a sum of money at a continuing medical education program, they fully expect to earn more than that sum by increased sales. No drug company gives away money in an act of disintersted generosity(2).

There are many of us who feel that a gift can be accepted without any obligation. This thinking is self-delusional-acceptance of a gift usually triggers feelings of. gratitude and reciprocation in the recipient(3). These feelings can, and often do, influence doctors' decisions with regard to patient care. In business, non-productive expenditure is rapidly eliminated. The fact that the tradition of pharmaceutical firms giving gifts to doctors has endured for so lung speaks for itself.

Pharmaceutical firms today try to influence the choice of subject and speaker at continuing. medical education programs, and even the content of the presentations. Such a continuing medical education program becomes a disguised promotional activity for the sponsor's products. Most doctors are sceptical about the claims made by pharmaceutical firms; the conference speaker who appears objective but favors a particular company's product can be very dangerous; It is becoming difficult to judge what to believe at continuing medical education programs in this era.

Care must be exercised in selecting the CME programs to attend, in order to prevent our minds from being influenced and our prescriptions subverted. Conferences and seminars arranged by reputed teaching institutions or associations, where a delegate fee is charged, are usually genuine. On the other hand, those arranged by pharmaceutical firms, where the attendees are given travel expenses, lavish hospitality, and expensive gifts, are usually promotional in nature, and should be avoided by all ethical medical men.

It is perhaps acceptable for the pharmaceutical industry to channel their support to doctors through non-profit societies and academic departments. These bodies, how- ever, must firmly exert their right to have absolute control over the faculty and content of any educational program. No relation is established between the sponsor and an individual physician, which gives some degree of respectability. Ultimately, as Dr. Agarwal says, doctors should learn to pay for their own education, meals and recreation.
 

Parang N. Mehta,
2-C, Anjani Towers,
Parle Point,
Athhiva Lines,
Surat 395007,
India.
 

1. Agrawal S. Medical profession and the pharmaceuticals: Indian scenario. Indian Pediatrics 1998; 35: 641-645.

2. Rawlins MD. Doctors and the drug makers. Lancet 1984; 2: 276-278.

3. Chren MM, Landefield CS, Murray TH. Doctors, drug companies, and gifts. JAMA 1989; 262: 3448-3451.