121st. Let's discuss the money for medicines. Medical students tackle conflict of interest issues.

Akihiko Ozaki, M.D., Ph.D. Physician at the Medical Governance Research Institute

Is there any influence from pharmaceutical companies on the medicines doctors prescribe?

On August 10th, 2024, medical students and young doctors tackled this sensitive issue head-on at a symposium held at the 56th Japanese Society of Medical Education Conference held at Teikyo University.

"56.9% of doctors meet with pharmaceutical companies at least once a week."

The results of our questionnaire survey, which was also introduced in the 119th (August 15th issue), were announced by Dr. Michioki Endo, a surgical resident at Hyogo Prefectural Awaji Medical Center.

Dr. Endo also announced the results of a survey showing that doctors who had more contact with pharmaceutical companies tended to place more importance on information from companies, and that 77.1% of doctors answered that ``information from pharmaceutical companies is neutral and accurate.'' In short, it's possible that many of your colleagues don't realize the seriousness of the situation.

So, how do medical schools educate about this issue? The next speaker, Natsuya Sakata from the Akita University School of Medicine, introduced the results of a survey on conflict of interest policies in medical schools across Japan.

The 78 medical schools were evaluated on the strength of their policies in 7 areas of conflict of interest, and scored on a 24-point scale, including the presence or absence of supervisory bodies and penalty provisions. The results showed that no Japanese medical school received a score of 8 or above, and no university "taught how to interact with pharmaceutical companies in medical education." This highlights the low level of interest in conflict of interest education in Japanese medical education.

However, this is not just a problem for Japan. According to Travis Lynes, a young Australian doctor, the situation is similar in his country's medical schools, and in fact shows no signs of improvement in the last 10 years.

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Why does this situation continue? Dr. Lynes points out that there is "an absence of an entity that is consistently tackling this issue." For example, he says that while he was a highly engaged medical student, it became harder for him to stay engaged as a busy doctor.

So, how can we improve the situation? Yudai Kaneda from the Hokkaido University School of Medicine has proposed a solution that uses "nudge theory" from behavioral economics. Nudge is an approach derived from behavioral economics that encourages appropriate behavior without using economic incentives or penalties by designing the environment in which people make decisions.

What Mr. Kaneda proposed here is the "default" setting, which is said to be the "strongest nudge."

In order to optimize doctors' prescribing behavior, it is extremely important that the design of "guidelines" that serve as defaults for prescriptions properly manages conflicts of interest, increases transparency, and makes them the standard of medical care.

In addition, the chairman, Dr. Eishu Nango of the Department of General Medicine at Seibo Hospital, also proposed incorporating conflict of interest education into the core curriculum of medical education. Dr. Endo, mentioned above, argued more directly that "it would be most effective if it were included in the national medical examination."

In any case, if we consider effectiveness, it should become the "default" to incorporate conflict of interest education into continuing education.

This symposium once again highlighted the possibility that doctors, who are at the center of medical care, are unwittingly influenced by pharmaceutical companies, while at the same time highlighting the current situation in which there is insufficient attention to this issue.

At the same time, however, I was very impressed and encouraged by the attitude of the younger generation in trying to tackle this issue seriously.

We must link the efforts of young doctors and medical students to building a more transparent and reliable medical system. As leaders, our awareness and seriousness are being tested.

This article was originally published in Japanese in Iyakukeizai (Pharmaceuticals and Economics) on September 15, 2024.