Wednesday, April 2, 2008

The Wall of Commercial Bias Keeps Crumbling Down

It's rare for an industry-friendly magazine like Medical Meetings to feature an article opposed to commercially-sponsored CME. And rarer still for the editor-in-chief to preface the issue with an editorial in support of this position. But we are seeing a historic sea change in public opinion, and the unpredictable is becoming commonplace.

First, read Tamar Hosansky's editorial, Fast-Track CME Reform. In it, she discusses the recent annual conference of the Alliance for CME, a trade group that supports commercial CME. After mentioning another trade group's announcement that it will start collecting data to audit bias in commercial CME (calling all hens--leave henhouse immediately!), Hosansky states her own opinion: "First, I believe the move toward curtailing commercial support is inevitable." Hardly naive, Hosansky appreciates "CME providers' reluctance to limit funding. But it's only by making fundamental changes to the financial and accreditation enforcement models that the CME community will begin to establish its credibility and reduce the threat of government regulation."

But the jewel of this issue comes later on, in Donna Beales' article entitled "5 Steps to Building Real Firewalls." Beales is the CME Coordinator at Lowell General Hospital in Massachusetts. It's unusual for a CME professional who stands to benefit from industry funding to take such a strong ethical stance. Or, as Upton Sinclair once said, "It is difficult to get a man to understand something when his job depends on not understanding it."

Beales argues, among other things, that physicians with commercial interests should be ineligible to present CME programs. I'll quote at length from this part of her article, but please go to the original to read the whole thing (I have bolded some passages in the second paragraph; the bolding in the third paragraph is in the original text).

"Increasingly, it's becoming a standard across all industries to disclose commercial interests. On most boards, if an individual has any conflicts, it's expected that he or she will be recused from voting on any issues that might involve personal gain.

Choosing to be a physician is a noble calling. Choosing to be a drug company representative may have lucrative financial returns for a doctor who is burned out with medical practice. Both are free enterprises. It's time to choose between one or the other — teaching, or hawking. They are not one and the same. In fact, education and enterprise are mutually exclusive. It's time for doctors to get back to the business of doctoring, and for those with aspirations toward the world of commerce to depart the profession for greener pastures.

If we're worried that we won't attract anyone to teach due to the lack of financial gain, then it's time to look at the whole structure of CME. No other educational program in the U.S. is free of charge to participants. Perhaps it's time to entertain the possibility that participants themselves should defray some of the increasing costs that will inevitably result from a real split between industry and medical education. Attorneys and accountants often pay for their own continuing education course work. If lawyers can afford to do it and bean counters can afford to do it, surely doctors can manage too."


Anonymous said...

It is nice that people write these things, but in the end, it is the deeds, not words, that will define the agenda.

Is this publication suicidal? Or are people trying to deflect by claiming sincererity to appease people like us who are challenging this system appropriately?

I honestly say I like to be wrong, because when I am, I usual am happy. Cynacism has some perks!

It is nice to see this info getting press, even if in a blog. As I said in the posting about the former rep comments, it is getting this info out that will have the true impact in this debate. We are the few, but power is in numbers.

I'm glad for the frequency of postings these days, Dr C.

Supremacy Claus said...

Here are lawyer programs. Place the pointer on any live session. Both institutes are non-profit. The ABA is like the AMA of lawyers. I am sure they have a small margin of profit.

Tell me the price.

Here is some perspective. As an 1L, I want a summer job for a little experience. I know far less about doing the law than a first year med student knows about doing medicine. $24,000 for 10 weeks.

As a grad, I have never written a demand letter in anger, except perhaps during my summer jobs. The med student has seen tons of patients, done surgery, interviewed hundreds of people if not 1000's. My new secretary has to tell the format of a brief. $160,000 out of law school. Those law associate years? No better than a residency program, except at $160K plus big bonuses.

If a drug company can bundle a lecture package, invite 300 doctors and provide a day long seminar, with minimal bias, and zero evidence of harm, that spares the patient the cost of mandatory events for $1200. At 50 hours required a year, each costing, $100 an hour unbundled, that adds $5000 a year per doctor to be passed on to working class people. So that single seminar of 300 doctors will cost patients $360,000, multipled by 5, around $1.2 million a year for the patients of only 300 doctors.

There are 900,000 doctors, each needing 50 hours a year by law to renew a license. At $100 an hour for unsubsidized CME, the bill is $4.5 billion a year. That has to get passed on to working people. If a doctor has a license for 40 years, over the career of the doctors, patients will have paid out $180 billion unnecessarily. If anyone thinks, that drug companies will lower their prices once relieved of the cost of CME... have a nice day, and get back on your delusion meds.

No harm is shown by these partisan, biased, left wing ideologue articles. These left wing haters must disclose they are self-dealing competitors of the CME programs, including Dan and East Coast Commie med schools.

Supremacy Claus said...

This is ridiculous, you say. You can do it for far less.

Go ahead, become accredited for Category 1 credit.

Daniel Carlat said...

Actually, my publishing company (Clearview Publishing, publisher of The Carlat Psychiatry Report) is accredited for Category One CME and I'm painfully aware of the expense. Nonetheless, we are able to offer CME for $7-$9 an hour and still turn a profit. I don't know where you got your $100 an hour figure, that's orders of magnitude more than any company charges.

Supremacy Claus said...

Dan: You cited the example of the lawyers. I linked to their programs for CLE, by their own associations, not seeking to make a big profit. It costs them $100 an hour of CLE.

Those rates are subsidized rates. Try leasing a hotel meeting room for 300 psychiatrists.

The solitary reading of your newsletter loses the value of networking, and that of the wisdom of the crowd. That is a big added value of the industry sponsored CME programs.

You are quite passionate about this subject. How many such meetings have you attended? At those meetings, how many utterances have you found objectionable and biased? Of the objections you had, how many did you openly express to the entire assemble?

If the answer was even as low as one, you informed 300 colleagues simultaneous. They profited from the wisdom of the crowd, the crowd that contained you.

James M. La Rossa Jr. said...

One critical distinction to note: Lawyers are NOT required to attend CLE meetings or be tested on reading materials for credits in order to retain their licenses to practice law. CE for lawyers is 100% voluntary.

True, there does not exist in law the equivalent of sponsors vested to the creation of a "CLE Industry." (The makers of law books have a captive audience.) Though some legal specialists have been making noises for years and have convinced some associations to mandate CLE, it is a miniscule group and, following what has happened in medicine, I wouldn't bet the farm that continuing education will gain any further traction among lawyers.

N.B. In the spirit of full disclosure, I am NOT a lawyer. I attended Fordham Law school in the 80s and clerked for a Federal District Court Judge in the Second Circuit, but left the law for good thereafter. Thank you.

ps -- if one wanted to take a Shakespearian-like dig at lawyers ("First, let's kill all the lawyers..."), duplicate FDA-like guidelines and ACCME-like standards, and apply them to the law! Mama Mia...

Supremacy Claus said...

Jim: If you passed 1L, you are lost to the indoctrination of the criminal cult enterprise that is the lawyer profession.