The role of the pharmaceutical industry in neurologic education.

Each year, the American Academy of Neurology (AAN)’s A.B. Baker Section on Neurologic Education conducts an Education Colloquium at the AAN annual meeting. The goals of the Colloquium are to heighten awareness, stimulate creative approaches, and foster dialogue among members regarding current trends, challenges, and opportunities in neurologic education. The theme of the 2004 Education Colloquium was the role of the pharmaceutical industry in neurologic education. Pharmaceutical companies are increasingly involved in neurologic education, partly because of recent dramatic advances in the pharmacotherapy of neurologic diseases, and partly because of economic trends affecting medicine and academic medical centers. The growing role of the pharmaceutical industry in education has both positive and negative consequences. Neurologists need to be informed about currently available medications and the clinical trials that provide evidence for their effectiveness. A major source of information is the material prepared by the pharmaceutical companies and approved by the Food and Drug Administration for drug labeling. For their part, pharmaceutical companies need to keep abreast of current trends and perceived needs in clinical and academic neurology. Furthermore, researchers in industry and researchers in academic neurology departments both benefit from openly communicating with each other. Thus, there are many ways in which industry involvement in neurologic education is desirable. At the same time, this interaction is fraught with risks, because the priorities of the pharmaceutical industry differ from those of clinical and academic medicine. Pharmaceutical companies will predictably emphasize information that puts their products in the best possible light, introducing biases that can be difficult for trainees and even teachers to recognize (for example, focusing on distinctions that are not clinically meaningful, downplaying adverse results, and minimizing the role of non-pharmacologic management and the use of generic and off-patent drugs). Financial support and personal relationships can improperly influence how neurologists and trainees make decisions about medications, how teachers present information (and even how they decide what topics to cover), and how investigators conduct and interpret research. I served as the director of the 2004 Education Colloquium. Section members participate in neurologic education at a variety of different levels, from medical student education through continuing medical education (CME), so I tried to include discussion of the pharmaceutical industry’s role in neurologic education at all of those levels. I invited panelists with a diverse range of relevant professional experiences, but I asked each one to focus on only a subset of the overall topic. Thus, although each panelist presented background information including the literature relevant to his assigned topic, no panelist was asked to present a more general literature review. In this article, I summarize the panelists’ remarks, but also provide an overview of the literature. Space constraints prevent a comprehensive review, but I have tried to present a representative sample of the types of investigations that have been conducted in this field. The results of many of these investigations can be interpreted in more than one way, and this topic tends to evoke strong emotional responses, so there is a risk of interpreting the results in a way that conforms to preconceived notions. I have tried to set aside my own biases and provide a balanced and critical analysis of the results. If there are flaws in the analysis, or in the review itself, they are en-