Monday, February 11, 2008

New MGH Psychiatry Academy: Take the Money, Say Nothing

In 2004, Massachusetts General Hospital's psychiatry department partnered with Primedia Healthcare and began soliciting millions of dollars from the drug industry to fund its CME programs. Called the "MGH Psychiatry Academy," this new program sent out glossy brochures to psychiatrists across the country announcing that "CME reform has arrived," and describing itself as a "revolutionary way to experience self-paced, unbiased and clinically applicable CME...."

The true "revolution" was the astonishing sums of money the Academy was able to rake in. The initial rumors had it that companies were required to pony up a cool million for whatever indirect influence they were to receive. Eli Lilly's grant registry website reveals that in 2007, they gave a total of $1.65 million, in three separate installments. Several other companies signed on as well, so this was about an $8 million cash cow for somebody. But for whom? Primedia was farming out the CME work to obscure vendors, such as "Trinity Healthforce Learning" and "CM Communications Group." A year ago, I made some half-hearted efforts to email the people at these companies who were responsible for producing the CME, but I received no response. It now appears that "CM Communications Group" is defunct, or at least it has dropped its web presence.

At any rate, in an apparent effort to make the Psychiatry Academy seem less crassly commercial, MGH fired Primedia, and has announced a 25 year "strategic alliance" with Reed Elsevier, an eminent medical publisher. But again, nothing is exactly what it seems in a world where so much money is being processed and where perceived legitimacy is crucial to the institutions involved. Reed Elsevier is farming the CME work out to another division, called Reed Medical Education. Reed Medical Education specializes in organizing huge meetings in oncology and other topics, and posts this price list of different ways that drug companies can give them a whole lot of money to be a part of a single medical meeting. Being a "cornerstone supporter" costs $195,000, "foundation supporter," $135,000, "leadership supporter," $95,000, and so on. Lord only knows what degree of influence over the medical mind each level of support might provide. Nor do we have any idea what the new MGH Psychiatry Academy price list is--remember, the price list above was for one meeting, while the MGH program encompasses dozens of live meetings and more web-based programs.

At any rate, the new and improved MGH Psychiatry Academy's first brochure just arrived in my mail box, and the reputation clean-up operation has begun in earnest: there is no financial disclosure mentioned. Multiple CME symposia are advertised in various areas of psychiatry lucrative to industry, and yet there is no mention of industry support, and no mention of personal financial disclosures of any participating lecturers.

Pharmaceutical support of a psychiatry department at this level is embarrassing, and Reed Medical Education has come up with its own, elegant solution: no disclosure at all.



16 comments:

Anonymous said...

It's nice to see a critical commentary about MGH. Please, more! And how about YNHH? You're current newsletter made a great point about the PRIME trials.

bmartinmd said...

Depending on the nature of the MGH-PA brochure (Is this an invitation to a specific event? A "we-exist" brochure? A "save-the-date" brochure?), the ACCME may not require that MGH-PA/Elsevier provide disclosures on the material. In any event, the commercial supporters for the 2008 MGH-PA curriculum (Lilly, AstraZeneca, Janssen) can be found at http://www.mghcme.org/?page=organization/supporters. The program curricula will be certified by the Elsevier Office of CME, which is accredited by the ACCME (http://www.mghcme.org/?page=organization/accreditation). I found this information very easily at the MGH-PA website, through the link you provided.

If you believe that MGH-PA/Elsevier are not in compliance regarding their disclosure of commercial support, contact Murray Kopelow, MD, MS(Comm), FRCPC, Chief Executive of the ACCME at mkopelow@accme.org. Then let us know what the response is.

Daniel Carlat, M.D. said...

I think you're splitting hairs. The entire MGH Psychiatry Academy enterprise could not exist without industry support, and it's outrageous that this mailing did not even mention it. I don't know whether they have run afoul of ACCME regulations, but they have flunked the sniff test of transparency and honesty.

And I heartily disagree that the industry support information was easily found on their website. It is disclosed nowhere on the home page, nor is it mentioned in any of the pages listing the detailed agenda of upcoming symposia. Furthermore, individual faculty disclosures are, as far as I can tell, completely absent from the entire site. To find out that Eli Lilly, Astra Zeneca, and Janssen are supporting the program, you have to click on "about" which is listed in the tiniest font and buried at the bottom of the page, notable "below the fold."

bmartinmd said...

Well, I guess it's how you define "easily." I certainly didn't find it difficult to locate the much-desired support information that you said wasn't disclosed. Now if the CME brochure does list specific events and faculty, my understanding is that the program's commercial support and faculty disclosures should be listed.

But why not inform the ACCME--the organization that's supposed to oversee this kind of stuff--of your objections regarding the apparent lack of disclosure on the brochure (which you did state was one of your objections)? The ACCME's response (and I'd be surprised if you didn't get one) is probably of interest to your blog readers. The ACCME (not me) may well split hairs in your estimation on the point of disclosure, but that would also be educational.

As another thought, why not inform MGH-PA and Elsevier (if you haven't already) of your concerns? Maybe they'll provide a link to the support at the website that's transparent by anybody's reasonable standards.

Daniel Carlat, M.D. said...

I may send Dr. Kopelow a letter about this, although I dare say that he must be tired of hearing from me. I've sent him letters outlining much more egregious instances of non-compliance regarding a CNS Spectrums piece (see blog entry:http://carlatpsychiatry.blogspot.com/2007/08/cns-spectrums-responds-sort-of.html) and a Journal of Clinical Psychiatry CME supplement (see http://carlatpsychiatry.blogspot.com/search/label/Journal%20of%20Clinical%20Psychiatry). On the CNS Spectrums issue, I eventually received a letter from Dr. Kopelow informing me that an investigation had been opened, and that was a long time ago. I never received a response on the J Clin Psych issue, but the journal is about to publish my complaint in their letters section.

Poor compliance with various aspects of ACCME's standards of commercial support occurs with such regularity that reporting such instances would be a full time job in itself!

bmartinmd said...

Ok, useful information. If you have the brochure or know where I can find it, I wouldn't mind taking a look. Thanks.

Anonymous said...

i have the same brochure, and pharma supporters of the MGH-PA are clearly listed on page 8. also, there is a Faculty Disclosure section, which states full disclosures will be provided at the events. i think this seems well within ACCME guidelines.

Daniel Carlat, M.D. said...

Apparently there are several brochures going out. The one I received has the following copy on the outer envelope: "Massachusetts General Hospital Psychiatry Academy is better than ever in 2008...." It is a 5" X 8" envelope and there are three separate pieces inside. The main brochure is a large piece folded up without page numbers and says "Event Calendar March-June 2008". There are no disclosures on any of these materials.

Stephany said...

Sometimes these things end up on the internet; I've found tons of stuff via digging,including detailed CME events and sponsors, etc.

Have you thought about scanning the paperwork you received and posting it here?

Sometimes photos are best descriptions.

Suicide Malpractice said...

Dan: I don't understand why you are so agitated about this subject.

http://www.thecarlatreport.com/index.asp?page=viewproduct&prodid=TCRB-11

Tell us if you have ever been more influenced in deciding on a treatment by drug company propaganda than by a patient's response.

Anonymous said...

what about if they had no commerical support at the time the piece was created? surely MECs cant go back in time and retroactively edit all materials. couldn't this be a possibility, given that surely their website and other materials apparently contain disclosure of pharma support?

Anonymous said...

Anonymous said...
Perhaps the 'target' is not the pysicians, nor the CME companies, nor Big Pharma. After all, it is the US Federal Laws that guide these interactions that should be targeted for allowing tax incentives to Big Pharma this way in the first place.

Ultimately, oiling the squeaky wheels of our dying uninsured patients is served by allowing the present Status Quo.

This discussion dovetails very directly with the building political pressure to make some major changes in the very foundation of the Broken US healthcare delivery system. And that answer lies in Universal Healthcare for all.

How does this appy to this discussion? Because, it is the political answer to the underlying problem. Capitalism and Medicine do not mix well. It either needs to be open market OR single payer system. Not our dysfuntional mess we have.

There is no reason Big Pharma cannot continue to exist making their wonderful progress and money for shareholders, while we physicians move into a fair, academic guided system that most all other countries have found success with (Like the VA here I might add).

The political tide will change this in the next year or two so we may as well get ready. I, for one cant wait. But then again, I must disclose I do not supplement my income whoring myself at speaking engagments, now or ever.

Good Job Dr Carlat! Now, lets put spotlight on these laws that allow and promote pyhysicians / Big Pharma conflict of interest in the first place.

Joel Hassman said...

I read the comments to these postings and I have to ask out loud who can responsibly challenge the reporting at hand here. If you are a health care provider, especially one who can prescribe, you have to at least ask yourself why are you not concerned about the role the pharmaceutical industry has in trying to influence prescribing habits. I have been practicing for 15 years now as a psychiatrist, and I am fairly much dumbfounded when I talk or hear colleagues defend their use of meds fairly much solely on the word of reps or industry sponsored literature.

When I learned of Dr Carlat's Newsletter several years ago, I was both happy and relieved that someone was making the effort to discuss psychiatric interventions for the sake of what is out there in as much an unbiased and objective manner. So, my comment to those who are offended or confused by what this blog and newsletter is offering, for what it is worth to said individuals, is some of us as concerned providers to our patients want what is responsible and prudent care options, NOT what will put money in people's wallets!

I do not speak for Dr Carlat in any manner, I just hope he continues his efforts to expose this travesty in Psychiatry.

Joel Hassman, MD

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Anonymous said...

Thank you for your continued efforts in cleaning up CME/CE. I have been an avid reader of your blog. Just wanted to lend a few points of clarity to the MGH story:

1. Harvard Medical School was the CME provider for the previous 3 years of the MGH-PA.
2. Trinity provided CNE and CPE for the first 2 years which was eventually provided by PRIMEDIA themselves this last year.

Thxs

Anonymous said...

'Take the money, say nothing'. Wasn't that directive taken from the prostitution industry?