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The Canadian Medical Association is facing criticism over its decision to team up with a major pharmaceutical company to create an education program for physicians across the country.

Some members of the medical community say the CMA is heading down a dangerous road and warn that partnering with Pfizer Canada Inc. may cross a serious ethical line that could negatively influence doctors' treatment decisions.

"My feeling is that the pharmaceutical industry has no business at all educating doctors," said Arnold Relman, professor emeritus at Harvard Medical School and former editor of the New England Journal of Medicine. "There's no question that if you're paying the piper, you influence the tune that the piper is going to play."

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The editor-in-chief of the Canadian Medical Association Journal argued in an editorial published last year that industry-funded physician-education programs are "unacceptable" and that a major overhaul is needed to ensure there is no hint of industry influence in educational programs.

"Physicians are seen as being aligned with the pharmaceutical industry and with its commercial priorities," Paul Hébert wrote in the March, 2008, editorial. "We seem to have conveniently forgotten that the pharmaceutical industry is in business to make money, not to educate health professionals."

Dr. Hébert sent a statement by e-mail Wednesday saying the medical association is a separate entity from the journal and that he is "not ready to comment on this specific initiative as I don't have all the salient information."

It's the second controversy to emerge in recent weeks involving Pfizer Canada and ties to a health organization. One of the company's senior executives was recently appointed to the governing council of the Canadian Institutes of Health Research, a federal agency.

Under the new CMA initiative, Pfizer Canada said it will provide $780,000 to fund the new "continuing medical education" or CME program, designed to inform physicians of new developments in medicine and help maintain their skills. Two Pfizer staff members will also sit on an administrative board, responsible for overseeing, implementing and evaluating the program, along with two staff members from the medical association and two individuals from outside organizations.

The program will be offered online and will focus on 12 different subjects. The first, expected to be made available early next year, will focus on Parkinson's disease. Other topics will be determined based on gaps identified by physicians in surveys posted on the CMA website.

Physicians are required to participate in CME programs, which are often run by universities and medical organizations, and must complete a certain number of credits, depending on whether they're a family physician or specialist. In order to be accredited, programs must meet requirements set out by either the Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada.

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The CMA will apply to them to have its new program accredited, said Sam Shortt, director of knowledge transfer at the association.

Dr. Shortt and Pfizer said the company will have no say in how content of the educational programs is developed. The groups are also following two ethics and transparency guidelines created separately by the CMA and Canada's Research-Based Pharmaceutical Companies, an industry group representing drug companies.

"There's no connection between the funder and the people who are actually providing the content," Dr. Shortt said. "We're confident that these two elements meet and exceed any expectations from any observer."

But experts who have studied ties between pharmaceutical companies and medical institutions say that despite the best intentions, influence from drug-makers often unconsciously sneaks into the relationships.

"Even under the best circumstances, there is the potential for influence," said Michael Steinman, assistant professor of medicine at the University of California at San Francisco.

Joel Lexchin, a health-policy professor at York University in Toronto, said doctors and other health professionals are often unaware of influence coming from drug companies because it's usually so subtle. But studies have shown that doctors are more likely to prescribe a particular company's drugs if they have a personal relationship with someone from that company.

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"It's not that the doctors are being bribed. It operates on a subconscious level," Dr. Lexchin said.

Dr. Relman, one of the most prominent advocates for a separation between medical education and profit-making entities, said the profession needs to closely consider what motives drug companies have for funding CME programs.

"It's simply a matter of common sense that if Pfizer is going to pay the Canadian Medical Association for medical education to doctors, Pfizer expects to get something in return," Dr. Relman said.

Heather Bisset, Pfizer Canada's manager of corporate communications, said the company's only aim is to "improve education that's provided for doctors across Canada."

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