Dinosaurs Roam the Earth Once More

The AMA House of Delegates had a chance to make history, but they flinched. Faced with their own ethics council’s recommendation to declare industry funded CME unethical, they had three choices: approve, reject, or delay. They chose to delay, referring the proposal back to committee.

While MECC websites crowed victory, in fact, this is not really their victory at all. The proposal will return. It will be tweaked to become less objectionable to some, and will be resubmitted in November or next June.

Yes, the medical dinosaurs are prowling the earth once more, and that crashing sound through the jungle is heard nowhere louder than in the editorial offices of Medscape, where George Lundberg, their editor in chief, released one of the more bizarre performances in recent memory. In this videotorial, Lundberg declares that CME is “under siege.” Consumer warning: if you watch this, be prepared to cringe.

Like a cornered animal, Lundberg widly lashes out at all progressive forces in medicine, including, in no logical order: Jerome Kassirer, the American Association of Medical Colleges, Jordan Cohen, the American Medical Students Association, the AMA’s Ethics Council, the Josiah Macy Foundation, Senator Charles Grassley, and even JAMA, the journal which Dr. Lundberg once edited. All of these individuals and institutions are part of the vast conspiracy to destroy continuing medical education. What irked me, though (aside from his failure to mention me in his Rogue’s Gallery) were his parting comments: “What does all this mean for Medscape and eMedicine, the largest single source of CE for health professionals? We are just going to keep doing what we are doing. It is good. We are clean. Our work is transparent.”

Good? Clean? Transparent? Are we still talking about Medscape, the discredited purveyor of drug company ads, disguised as CME?

In a prior post, I deconstructed this offering funded by Janssen in which good, clean, and transparent Medscape editors scoured the ends of the earth for the single case study that might make Invega look good—and then created a CME article out of it.

Lundberg’s preposterous opinion piece prompted me to dig a little more deeply into their CME, and it gets worse. Let’s go down the list of their industry-supported CME (there are a few token non-industry funded articles sprinkled in here too). We’ll start with New Data in the Recognition and Management of Bipolar Disorder, an article funded by Lilly, which mentions their Symbyax (a combination of Prozac and Zyprexa) over and over again. When Lilly funds a CME, the editors know exactly what they are paid to do: discuss Zyprexa in a way that downplays its infamous metabolic dangers. True to form, here is the only discussion of weight issues in this article:

“Dr. Thase: Well, the good news on both OFC [Symbyax] and quetiapine is that they do not cause switching, do not induce cycling, and the primary metabolic consequence is weight gain, which is very reliably, accurately measured sequentially and you see it coming. No one will gain 5 kg without first gaining 2 kg, and particularly when they're warned ahead of time. So I would say 1 thing for the interest of primary care prescriber would be to gain some comfort with at least these 2 members of the atypical antipsychotic class, engage the patient in collaborative care and follow-up, watch weight gain closely.
The diabetes risk independent of weight gain is rare. It does happen, but you will need to treat well more 100 patients before you actually see someone who develops new-onset diabetes out of the blue, so it is a real consequence, but a rare one and the dyslipidemia is almost entirely weight dependent. So if there is no weight gain, there will be no dyslipidemia.”

This is the gentlest discussion of Zyprexa’s side effects that I’ve ever seen. The activity is ostensibly a discussion between luminaries in psychiatry, and I’m sure that’s how it began. But the editors can cut and paste interviews to achieve a variety of results--I should know, because I do this every month for my own CME newsletter. When I edit my interviews, I do so for clarity and conciseness—but when Medscape edits, they do so to push the sponsor’s product.

Lundberg: “We are good. We are clean. We are transparent.”

Next up: “The Evolving Management Paradigms for Pediatric ADHD.” There isn’t even an effort to provide the illusion of balance in this CME article. It quite simply a parade of praise for Shire products. After the introduction, ten of the first ten slides on treatment are advertisements for Shire products, in this order: Vyvanse (two slides), Focalin (two), Daytrana (three), and Guanfacine XR (three). How will Medscape defend the integrity of this article to ACCME? They will say that the article’s focus is on new ADHD treatments, and it just so happens that Shire has produced them all. It’s a beautifully-honed method of turning CME into promotion while skirting regulations. “It’s not biased—we just chose a topic that inevitably makes our sponsor’s products shine.”

If you keep going down the list, you’ll see the same pattern. Each CME article is biased in favor of the sponsor’s product.

Note to Dr. Lundberg and Medscape: what you are doing is not clean, not good, and most definitely not transparent.