Textbook revamps U of T curriculum

A complaint lodged in early 2010 by an unidentified student and two doctors in the faculty of medicine about a textbook has prompted U of T to change its curriculum. The complaint was about perceived drug industry involvement in a textbook on managing chronic pain that was funded and copyrighted by the makers of the prescription painkiller OxyContin.

Dr. Rick Glazier and Dr. Philip Berger, both physicians at St. Michael’s Hospital, one of University of Toronto’s teaching hospitals, had asked for the inquiry. They were approached by a medical student who was concerned about the industry-sponsored book brought to the university’s Centre for the Study of Pain.

Dr. David Mock, the dean of dentistry at U of T, said in an interview with CBC News that the 371-page book had been provided to students by an unpaid guest lecturer with ties to the drug company.

Lorraine Ferris, the inquiry head, reports that she has not found evidence of wrongdoing or actual conflict of interest.

However, her report for The Canadian Press says that “time is of the essence” in revising the curriculum of the 20-hour course taught to students in medical, dental, and pharmacy school. She said in an interview with CTV News that planning for the revised curriculum needs to begin soon, in time for delivery of the next course this spring.

In her report, Ferris said the revised curriculum should include delivery of balanced information by experts in several fields, including pharmacology and painkiller addiction.

“As part of their discussions, faculty will need to address important, topical, and often sensitive issues regarding opioids—including, for example, opioid addiction, improper opioid prescribing, at-risk communities, illicit sales and drug diversion, ‘double-doctoring’, and recreational sharing and use of opioids,” Ferris commented to CBC  News.

In an interview with CBC News, Berger said, “[Ferris] has met our concerns head-on,” and was pleased by her inquiry. “To me—and, I think, quite correctly—she’s called for a higher standard in a public policy area of a very high profile and of interest to both government and the public. I think it’s fair to say that the implementation of professor Ferris’s recommendations will make the public safer and likely will save lives.”

Ferris also suggested that the curriculum, development, and accountability for the pain course be transferred from the Centre for the Study of Pain, which conducts pain research and helps educate doctors, dentists, nurses, and pharmacists. Rather, the Centre for Interprofessional Education, which takes a multi-disciplinary approach to developping the skills of health professionals, should now take over curriculum and accountability. Ferris also recommended that only U of T faculty members teach the pain course.

“I think this is a good thing,” Mock said in an interview with CBC News. “I’m not looking at this as a hand-slap for the [pain] centre. I think what we’ve done is move it into the more modern governance system that we are developing at the university.”

Mock stated that from 2002 to 2006 the pain course was funded by donations, including $117,000 in unrestricted educational grants from four drug companies: Merck-Frosst, Purdue Pharma, Pharmacia Canada, and Pfizer; the drug companies had no direct  input on the course content. Since 2007, the program has been funded solely by faculty budgets.

Purdue’s copyrighted book on pain management had been brought in by Dr. Roman Jovey, an unpaid guest lecturer and co-author of the book who left copies “for anyone to take”. Jovey, medical director for a chain of clinics called the Centres for Pain Management, is a member of Purdue’s speakers’ bureau, paid by the company to conduct workshops and lectures.

Jovey confirmed in an interview with CTV News that he had left copies of the book, entitled Managing Pain: The Canadian Health Care Professional’s Reference, for students.

“It was a gift from Purdue. I’m not at all embarrassed or ashamed. I think it’s a darn good book,” he said. “If we all want to be politically correct and have the appearance of being politically correct, then I guess I get it—that nothing that has any kind of pharma logo or name or ownership should be given out to medical students.”

In an interview with CTV News, Berger said that report raises the issue of the pharmaceutical industry potentially affecting undergraduate medical education in general.

“The danger is an obvious one. It is in the interests of the drug company to have physicians prescribing as many opioid medications to as many patients as possible. It’s the only way it makes its money,” said Berger. “So it raises a very serious question about whether industry-sponsored speakers or materials should ever be used in undergraduate medical education because the primary interest of the pharmaceutical industry who makes these drugs is to have people on the drugs—not to educate students properly.”

“This would apply to any disease that requires medications.”

Recently a study was published showing prescription rates for opiods, including OxyContin, which had soared in Ontario over the last two decades, as well as the number of deaths linked to the narcotic.

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