James M. La Rossa Jr. built a medical publishing empire and knows a thing or two about industry-funded CME. He founded CNS Spectrums and Primary Psychiatry in 1997, and sold them to its current publisher in 2003. Aside from publishing the journals T.E.N. and Mental Fitness, he recently rescued the journal Psychopharmacology Bulletin from oblivion by buying it from NIMH, which wanted to get out of the medical journal business. He got out of the commercial CME business in 2001 because he couldn't stand what it was becoming.
I spoke with La Rossa, who had commented on a recent posting on unsavory CME manipulation.
Dr. Carlat: As publisher of various psychiatric journals, you could have made a ton of money publishing commercial CME articles. Why didn't you?
La Rossa: First of all, I am in media, which I love. I did not want to be in the CME business. Going from venue to venue to put on the exact same CME programs -what I refer to as the dog-and-pony show-had no attraction for me. I gave up a potential law career to be a journalist and publisher. The most important job of any publisher is to influence a field of interest, make your publications an indispensible part of that field, and, most importantly, play the game while keeping your third party credibility. Once you lose that independence, it is next to impossible to regain it.
Dr. Carlat: Do you think it’s possible for publishers take industry money for CME material in an ethical way?
La Rossa: I don’t think so. In my experience, the publisher inevitably becomes nothing more than an agent of the sponsoring pharmaceutical company. Rather than producing true medical education content, they are customizing intellectual material for pharmaceutical companies. While there is nothing inherently wrong with this, where it gets sticky is when the publication runs the customized project as a CME activity in the journal, which automatically implies that the project is sanctioned by the journal's editors, board of advisors, etc.
Dr. Carlat: The scale of the CME enterprise has certainly mushroomed over the past several years. Why?
La Rossa: Several reasons. First, of course, is that people began to see how much money there was to be made, and that has attracted many companies in itself. But another driver of this enormous CME problem can be traced back to about 5 years ago when the APA began to get very aggressive about retaining exclusive rights to any and all symposia. What they were doing was trying to prevent sponsors and/or outside CME companies from profiting off of these symposia. These companies responded by inviting the APA speakers to a hotel near the meeting, for example, to give the same talk. They changed the title, said it was in "conjunction with the APA meeting," or language like that. In other words, as the APA tightened controls to the dissemination of CME materials to psychiatrists, a CME free-for-all started as private content providers started coming out of the woodwork. It sounds like I am putting most of the blame at the APA's door, which is unfair. Universities-who view CME as a profit center-are getting in on the action as well. But I do think that the APA should stick to what they do best: Make excellent journals and books. Isn't that the very heart and soul of psychiatry?