13 January 2001 from the Dutch national paper Trouw, p. 13 (unofficial translation)

Topping off education in the mountains

by Joop Bouma

A weekend sunning on an island or at a ski resort and at the same time taking a continuing education course. The drug industry puts millions of guilder into this. And at the same time has GPs firmly in its grasp. The ads creep in silently.

Continuing education

In nine of the 18 continuing education courses that controllers from the National GP Federation LHV visited last year and in 1999, the drug industry was found guilty of promoting drugs. The Dutch Inspectorate for Advertising Control, a part of the Ministry of Health, is very worried about that result.

But the reality is more serious. Out of 27 visit reports made available to Trouw, which include the reports the Ministry may make public today, it appears that pharmaceutical producers are gaining a greater grip on the required continuing education of GPs. Of the 27 courses that the LHV visited between 1998 and 2000, in 22 cases the content of the continuing education was completely or partly determined by a drug company. Of the 22 courses, 15 or 68%, were used to promote a drug produced by the organising company. Some examples are given on the bottom of this page.{This page has not yet been translated.]

Now that drug company promotion must adhere to sharper (European) rules, the industry is putting more money into the organisation of continuing education. This involves millions of guilder.

The courses are often made as attractive as possible: a combination between a weekend sunning on a Wadden island, or a tailored course programme in a beautiful ski resort. Almost every week, somewhere in the Netherlands or somewhere else in Europe, a handful of doctors meet for sponsored continuing education.

Of the 22 courses of the industry, other marketing goals were also attempted: such as stimulating sales through the subject matter--a few years ago erectile dysfunction was a scarce subject for continuing education, since Viagra is on the market, there can't be enough courses. The promotion of commercially directed standpoints, through the targeted selection of speakers, has become an important marketing goal. The professor of psychiatry gives a GP course about anxiety problems based on his experience with difficult patients and therefore he pleads especially for the prescribing of drugs. And then for pills out of the newest category. Drugs that are the national standards for GPs, he calls "classic", that is, old.

The question is if it is a good thing for the resource-rich industry to dominate medical continuing education. Although the 7,000 GPs in the Netherlands have access to other, objective sources of medical information, it is clear that industry's grip on continuing education grows greater as advertising rules become more strict. There has not yet been a discussion about this subject within the GPs group or medical specialists.

Doctors that take part in the courses say that their academic background makes it very possible for them to separate promotion from solid information, but they don't realise how subtle the promotion can be. Smart marketing techniques are used. Often the industry brings in specialised advisors to set up the courses.

Since 1996 GPs must get 40 study hours of continuing education each year. This can be done by attending courses that are accredited by the LHV, which has been approved after testing by the internal advertising code of the federation and the European rules on advertising of drugs.

Since 1997 some 800 continuing education courses have been approved by the LHV. Of them, only 27 have been visited by doctors representing the LHV. The LHV checks the courses' content only. Related affairs, such as thank you gifts (a set of golfclubs as a present after participating in a course) haven't been registered by the LHV since 1997. According the LHV, checking the upholding the law is the role of the government. Within two weeks after the LHV announced in 1997 that it would no longer check thank you gifts, came, for the first in a long time, a request to accredit a one hour meeting followed by a luxurious dinner.

The new Inspectorate of Advertising Control for the first time took a drug company, Merck Sharp and Dohme of Haarlem before the court for its entertaining of doctors. In 1999, MSD organised 20 ski and go cart races for groups of Dutch and Belgian doctors accompanied by a lecture promoting the migraine drug Maxalt.

Afterwards, MSD invited doctors for weekends on the island of Terschelling with live performances by artists, all in order to get its new migraine drug "in the pen" of the doctor.