A Behind-the-Scenes Look at Medical Education

money

Today, I’m going to take you on a little behind-the-scenes tour of what really happens with medical education and Big Pharma from my perspective as a community physician. Sometimes I forget that not everybody understands this, since many of my friends are physicians.

Doctors get continuing medical education (CME) through events like lectures and conferences. CME is necessary because many physicians practise for 30 or 40 years, and medicine is changing continuously, so they cannot rely on their medical school training, which might have happened in the 1960s. Doctors are required to get a certain number of hours of CME every year.

You might imagine that doctors learn from unbiased experts dedicated to learning. Actually, nothing is further from the truth. The dirty little secret is that virtually all CME is sponsored heavily by Big Pharma giving them huge influence over what information is presented to doctors.

Every single level of CME has been corrupted by $$$. Let’s start at the bottom.

Big Pharma and lectures to doctors

In virtually every hospital in North America, there are lectures called ’rounds’. They happen in every specialty and almost every single day, mostly at lunchtime. What a great idea. Doctors would spend lunchtime teaching each other the intricacies of their specialty.

Sorry, no. Most doctors are too lazy to prepare a full hour’s worth of lecture topic. Most are too busy to spend an hour listening to a the lecture anyway. So, the friendly drug rep from Big Pharma helpfully gets lunch for everybody. Free lunch! That helps bring in the audience, but it doesn’t help the fact that they still need a speaker.

grandrounds2015Once again, the drug rep is able to produce speakers! Big Pharma hires doctors to give lectures. Of course, these doctors are still too busy to produce their own talks, so luckily, Big Pharma also makes the entire slide kit with full notes so all the doctor needs to do is parrot the words written for him. He only lends his name to give these lectures the sheen of respectibility. You can be sure that these ’rounds’ always support the use of more and more medications.

The standard rate in Canada to give one of these talks is $1500 for a single hour of work. Very lucrative, even if it means you need to prostitute yourself intellectually. Perhaps surprisingly, there is no shortage of doctors willing to give these talks. Some doctors give talks several times per week. Almost every doctor at the major universities is available for hire.

Lavish dinners at fancy restaurants

Next, there are the dinner lectures. These, once again are helpfully organized by the Big Pharma drug reps. They invite local doctors to hear an ‘expert’. Once again, the doctor selected is ‘conveniently’ provided with the entire presentation to give like a trained monkey – delivering the exact message Big Pharma wants.

Who are these doctors selected to speak? The ones that prescribe the most drugs, of course. So, they have no problem giving these talks because they already believe it. It’s essentially a giant infomercial.

According to regulations, these dinners are not supposed to be lavish. They should be the equivalent of cafeteria meals. Does that happen? Not a chance in hell. These dinners are held at the fanciest restaurants available. Of course, it comes with wine and a 3 course dinner, which normally would cost about $150 per person. The speaker gets $1500 for one hour.

I must confess here. I have given a few of these talks, but have only done 1 in the last five years, because it was a journal club specifically requested by my friend. However, I only present my own slides and I do not accept any restrictions on what I say.

I stopped giving these lectures because I was just disgusted. The doctors in the audience were mostly interested in eating and clearly not even listening. It was awful. The money is good, but my soul paid the price.

“Legitimate” organizations funded by drug companies

The next place a doctor might expect to get CME is through conferences and other symposia. Often these are arranged through official sounding organizations – usually something like ‘Canadian Association of Superior Medical Knowledge’ (does not really exist). The public, of course, thinks these are legitimate organizations.

The doctors know full well that these are puppet organizations funded by multiple drug companies. This allows them to pay salaries to physicians to do little other than be the figurehead – always from a prominent university to give the organization a respectable veneer. You know, science director, medical liaison etc.

They organize one or two day conferences at hotels which usually include about 6-8 hours of lectures full of ‘experts’.If you had to pay for hotel space and speakers, these conferences would normally cost about $500 per person to put on. However, doctors usually only pay $25 for two days of lectures and this includes breakfast, snack and lunch! With a wink, they are usually free.

Sad to say, these are, once again, thinly disguised drug infomercials. Almost all of the speakers are university doctors, who know a good payday when they see it. I attended one of these many years ago. Two prominent university professors presented about diabetes. “There is a wonderful treatment that lowers weight, blood pressure and blood sugar with no side effects. It’s called exercise.” Oh, this sounds promising.

He then spent the next 59 minutes of his 60-minute lecture talking about … drugs.

The very next speaker, who writes the Canadian Diabetes guidelines said “The first, second, and third line treatment of diabetes is lifestyle, lifestyle, and lifestyle”. Oh, this sounds promising. She then spent the next 59 minutes of her 60 minute lecture talking about … drugs. Oh, what drug whores.

Drug companies fund research at universities

Perhaps you think that things are better at the major universities. Sorry, that’s not really true either. The people who are promoted in the university hierarchy are not those that are the most intelligent. No, it’s those who bring in the most research dollars.

Of course, it’s extremely difficult to get funding from governments. Instead, it’s far easier and far more lucrative to get drug company funding for research. This is often in the form of endowments and endorsed chairs. The biggest suck-up to Big Pharma gets the promotions. It’s sickening.

researchWhat happens to all the money you donate to ‘support research into diabetes’? Well, most of it goes toward paying for fancy hotels, fancy meals and fancy trips. Oh, of course, they can’t call it that. Instead, conferences are held in swanky hotels in far-away places. Why do most doctors go to the ‘European Conference on Amazing Medical Knowledge’? (does not really exist). Let me tell you, it’s not to get amazing medical knowledge. Hell, that’s available online for free in your underwear.

No, the main purpose is to visit Paris, or Copenhagen, or Barcelona. You take the research dollars donated in good faith and spend several thousand of them to go to Spain. You listen to one lecture and spend the next 3 days going to the fanciest restaurants you can find – all for research, of course. I know. The research budget is used to pay for airfare, hotel and meals. Of course, you usually meet up with drug reps for even fancier meals. I did this 20 years ago, when I was a student at the University. Everybody knows the game. Except you, that is.

Too harsh? Well, let’s think about this logically. Consider the hundreds of millions of dollars raised for diabetes and breast cancer and heart disease and so on. What do we have to show for it? Almost all of the drugs developed for all disease are developed by drug companies. Virtually nothing useful comes out of the universities.

All of the funding ever done at the universities adds up to a giant zero. While you might imagine that doctors and academics at major universities are immune to the influence of Big Pharma, you’d be exactly wrong. These institutions are on the take on a massive scale. They don’t simply take a few dollars here and there, they take millions of dollars.

They are the biggest drug whores on the planet. They give the word ‘whore’ a bad name. At least the sex worker is upfront about what is about to happen. Academic doctors give the entire group a black eye. They take blood money and pretend that they are giving you an unbiased opinion.

Coca-Cola gets in on the action

The University of Colorado, for example, received $1 million from Coca Cola in order to establish an advocacy group that, surprise, surprise would downplay the risk of sugar. You, as the public, would have assumed that this opinion exonerating sugar was coming from academic physicians who have thought long and hard and researched day and night about the best diet. You would have been exactly wrong.

Their opinion, backed by the name of a prestigious university, is for sale to the highest bidder. These same doctors and researchers are always the ones talking about how you can’t trust all the opinions on the internet. Turns out, the last person to trust was them!

Dr. Blair from the University of Colorado was busy blaming the media for the obesity crisis when he was taking blood money to fuel the crisis. They returned the money, but only when it was exposed in the New York Times. Otherwise, we would have been reading opinions that we believed were honest ones from university professors, but were nothing more than paid infomercials.

The list goes on and on. The Academy of Nutrition and Dietetics received $1.7 million from Coke. They represent the dieticians of America. Do they have our best interests at heart? No, you can’t bite the hand that feeds you. So sugar is fine and calories are the problem. Yes, because eating 100 calories of sugar and 100 calories of broccoli are equally fattening. Right.

Coke has spent $120 million since 2010 to fund research. Research that will undoubtedly show that sugar is not to blame for obesity. This makes the few bucks the community doctor makes seem like chump change. $120 million dollars!sievenpiper2 And then the academics will bleat on and on about how we must follow evidence-based medicine when the entire evidence base has been corrupted by commercial interests. Hypocrites.

Consider the case of Dr. John Sievenpiper. He is one of the most outspoken, staunchest defenders of dietary sugar. He is constantly in the media defending sugar. Oh, it turns out he receives money from the Corn Refiners Association!

In his paper in the Annals of Internal Medicine defending, you guessed it, sugar, here’s his list of conflicts of interest:

Conflicts

Summary

As a physician, I’m well aware that academic physicians’ opinions are for sale. It’s pretty obvious. They spend their days reading and writing research. Which is great, except that doctors get paid to see patients. So academic doctors often do not make as much as their community colleagues. They make it up by taking drug company money. They are trading the prestige of their institution for dollars. I know this. Unfortunately, most of the public does not.

So be careful who you listen to. There’s a lot of paid infomercials out there that you don’t even know about. Ultimately, you must decide who to trust based on their message, not their titles. Your life, very literally, depends on it.

Jason Fung

Earlier with Dr. Fung

The Common Currency in Our Bodies Is Not Calories – Guess What It Is?

Why the First Law of Thermodynamics Is Utterly Irrelevant

How to Fix Your Broken Metabolism by Doing the Exact Opposite

Top videos with Dr. Fung

  • How to Maximize Fat Burning
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  • How to Reverse Diabetes Type 2
  • Breakfast! Is it really that important?

More

A Low-Carb Diet for Beginners

How to Lose Weight

More with Dr. Fung

Dr. Fung has his own blog at intensivedietarymanagement.com. He is also active on Twitter.

His book The Obesity Code is available on Amazon.

The Obesity Code

11 comments

  1. Renee S.
    After reading your book, along with changing my eating habits and reading about how the Food Pyramid is a big lie, I have recently been looking into information about vaccines.

    A friend's daughter had an adverse reaction to Gardisill. She developed Type 1 diabetes, at 17, after receiving the 3 rounds of shots. Her mother is an RN and fully believes it was caused by the vaccination. It's the same thing as your article. All the information given to Doctors about vaccines are provided by the drug company. Vaccines have become the third rail. It's like a religion. If parents dare to question the Doctor, they are kicked out the Pediatric practice. Most of the research into the safety of vaccines is provided by Big Pharma. Doctors are trained to bully parents into getting shots, multiple shots per visit....even though the insert provided with the vaccine says not to give when sick, with other shots, etc.

    I recently viewed the movie, Vaxxed. It's about a CDC whistleblower who has come forward and said they destroyed data 14 years ago showing the connection between Autism and the MMR. It's the same thing! Big Pharma says their product is safe and effective, but they are the ones doing the research studies, or funding them.

    Andrew Wakefield questioned the connection 20 years ago and was tarred and feathered for it. So now no one wants to say anything, about any drug, for fear of being ' Wakefielded'.

    Dissolving Illusions by Susan Humprhries (a book about the history of vaccines) should be on everyone's reading list, along with your book, The Obesity Code. I've been telling everyone I know they need to read it.

  2. Tor H
    CDC Admits Fabricating Link Between Zika Virus And Microcephaly

    http://yournewswire.com/cdc-admits-fabricating-link-between-zika-viru...

    Reply: #8
  3. Tim
    A very good history of how we came to have such a disfunctional medical system...

    Murder By Injection by Eustace Mullins

    http://www.verontrustemoeders.nl/Murder%20by%20Injection.pdf

  4. Maura
    Dr Fung wrote: "Which is great, except that doctors get paid to see patients..."

    Physician friends tell me that it is simply not possible to address or treat diabetes, nor any chronic condition (or 'lifestyle illness'), in a 10 or 15 minute appointment. That short amount of time puts the focus on writing prescriptions, and there is simply not enough time to uncover the roots of health problems.

    That economic model works to Big Pharma's favor over the short term.

    However, I definitely have the sense that a lot of patients are, like myself 'sick and tired of being sick and tired' and are actively seeking alternatives. Articles like this one help confirm that those of us working fairly consistently to get off Big Pharma's meds are acting in our own best interests.

  5. jane
    WOW! Go Dr. Fung! Aren't scientists supposed to be above all that money stuff? Yes, I know I am delusional.
  6. Nadine
    Thank you Dr. Fung! Way to tell it like it is - don't ever let yourself be silenced!
  7. Nani
    I suffer from migraine. At my last neuroligist appointment 3 years ago, a lady with long legs and short skirt saw the doc before me (a pharma rep). Then I started to tell the doctor about my migraine story, he did not let me finish and said I should try Topamax and started printing out the recipe. When I argued I had tried before and did not work for me, he said I hadn't probably try the right dosage. I left his office with a recipe, and in tears, I drop it in a trash can and realized I was alone. It was when I started with LC by reading Peter Merschs book (in German). It has not been a miracle cure for me, but Im hanging in there without medication other than magnesium and old fashion Antihistaminic now and then. Thanks for your courage to write this article, thanks dear Andreas and team. I feel no longer alone ?
  8. Renee S.
    Accidentally hit report instead of like.
  9. Eric Sodicoff, MD
    It goes so much further than drug company slides.The entire medical literature regarding drugs is thoroughly compromised. First, drug companies routinely bury unfavorable studies. Then they design studies that slant the odds of a favorable outcome in their favor. Then, if they don't get the result they were looking for as the primary outcome, they find some other subgroup or secondary outcome that was more favorable and claim that is what the study is all about. Then they use sketchy statistical tricks to skew the results and then they add some spin in the discussion and conclusion sections. All you need to know regarding a published drug study is who sponsored it. You can then skip reading the paper if it was funded by the drug's maker because you know all you need to know to guess the positive outcome almost 100 percent of the time.

    After reading "Bad Pharma" by Ben Goldacre I became convinced that I literally knew nothing about the drugs I use because drug companies only let us know what they want us to know about them. I stopped attending drug company sponsored programs years ago. I have no idea if what they say is true. There is very little way to find out.

    Drug lunches are all about selling product not curing disease. On twitter, I post photos of "food" the drug reps bring to entice doctors to talk with them. The diabetes drug salespeople invariably bring by crappy carbage. It's crass. "Doctor. Lemme talk to you about Invokana while you munch on the pastries I brought to the office." I haven't seen the Chantix rep lugging in cartons of Luck Strikes, but selling diabetes drugs with sugary food is the same.

    Part of the reason most doctors don't believe in the power of food to prevent disease is because the drug companies actively promote the wrong diet. I believe the ADA diet was invented by the drug companies so it would inevitably fail rapidly. Patients are forced to use meds.
    Exhibit A: French toast recipe brought to you by Januvia:
    http://www.januvia.com/sitagliptin/januvia/consumer/living-with-diabe...

    You won't see drug companies talking up LCHF....everrr because it actually works.

    Reply: #11
  10. Mark Bousquet
    For-profit health care... giving outdated advice to keep people fat and sick, prescribe them medication, and even many more medications when they return because of the side effects of the previous medications they were given and so on and so forth. $$$$$$
  11. Mark Bousquet
    There's no profit in LCHF until they've replaced all our food with GMOs. Then we really will all be sick and in need of drugs!

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