Indian Journal of Medical Ethics

Medical conferences are fast degenerating into melas which educate, entertain, amuse and irritate and deceive - not necessarily in that order. One can smell, see and feel the drug industry everywhere, advertising on the walls, shaping the contents and style of educational programmes, tempting with gifts and free meals, travel and other amenities.

We conducted a two-day CME on critical care in community hospitals at our institute in October. Eleven speakers covered 23 topics in the CME which was attended by 240 delegates.

Rs 3, 81,000 was raised through registration fees, a grant from the Medical Council of India and drug companies. Ninety-nine consultants and 79 faculty paid Rs 400 and 61 residents paid Rs. 250 as registration fees (total Rs 81,000). The MCI gave Rs 80,000 to pay for travel and accommodation of a foreign speaker and to produce the conference's print proceedings.

Sixteen drug companies paid a total of Rs 2.2 lakh towards the CME. In exchange, they were permitted to set up booths along a passage next to the conference hall. Their banners were restricted to this area. They were asked not to offer gifts of any kind, or to organise any 'games'. They were also asked not to sponsor any hospitality or indsividual speakers.

The conference cost us Rs 3, 28,000 - Rs 72,000 for speakers' travel (air travel to five and AC two-tier train fare to another five), Rs 36,000 for accommodation and transport, Rs 72,000 for food, Rs 17,000 for bags and the rest for communication, printing, and other programme activities.

We limited the presence of the drug industry but failed to keep it out altogether. Is it possible to organise a CME without industry funding? We think it is. Had we collected Rs 1000 from each delegate, we could have met all our expenses (through delegate fees and MCI funds) without drug company funding. By doing away with bags and keeping better track of other expenses we could have saved about Rs 20,000. A two-day conference with about 200 delegates and 10 speakers held at our institute should cost a little over Rs 3 lakh.

In a meeting with the Institute's management we pointed out that when drug companies sponsor educational programmes, our students and residents get a distorted view of the doctor- industry interface. We pointed to the examples of a paediatric conference in Nagpur and another on ethics, both organised without industry support. We pleaded that Sevagram could - and should - set an example with industry-free CMEs. We stressed the need for regulations governing all medical conferences in the institute.

Barely a week after the conference, the college council members discussed means of reducing the role of the pharmaceutical industry in sponsoring medical education at MGIMS, and shaping doctors' prescription habits. At the end of the meeting, the council took two path-breaking decisions.

First, companies marketing drugs and medical equipment may no longer support any programme in Sevagram. CME organisers may not accept advertisements or money from drug companies in order to publish conference proceedings, souvenirs or information leaflets.

Second, the institute committed to underwrite a substantial proportion of conference expenses. The rest would have to come from delegate fees, and grants from the MCI and government funding agencies.

Some doctors fear that without funding from the industry, we will not be able to invite good speakers. Also, the quality of hospitality, including the food, could be affected. We feel that these fears are irrational. As for doctors' obsession with culinary delights, are lavish lunches, dinners and drinks more important than food for thought?

Doctors everywhere also have a strange predilection for freebies. Dr MK Mani wrote of one conference, "We can easily afford to buy an odd pen or briefcase, a flask or a shopping bag. Yet no sooner did some company announce on the very loud audio system that there were some goodies available at some stall, a long queue would form there leaving the speaker to cast his wisdom on empty chairs. Do we need to demean ourselves to this extent? Should we allow commercial interests to dominate us so completely?" (1)

Doctors should know that there is no such thing as a free lunch. After attending sponsored conferences, irrational prescriptions will start flowing from their pens. And the cosy relationship between doctors and medical representatives does not escape patients' discerning eyes.

Also, conference s held at five star hotels are bound to be expensive, more so when there is no pressure to check wasteful expenditure. Our experience shows that we can conduct an educationally useful programme in a medical college at just a little over Rs three lakh. Doctors in India can surely afford to pay Rs 1,000 for a conference. Institutional support will reduce the figure further.

Last year close to 11 billion dollars were spent on funding medical conferences the world over. We are experimenting with the idea that simple, quality educational conferences can be held without the industry's involvement, provided there is some institutional support, and delegates agree to pay for their own education. Will they or won't they?

S P Kalantri,Professor of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra 442102. Email:sp_kalantri@rediffmail.com