Friday, July 18, 2008

In Industry CME, $85,000 buys you 90 minutes, $103,000 buys one article

I recently received an e-mail inviting me to register for a big psychiatry conference in New York City. Called the “Third Annual American Conference on Psychiatric Disorders,” it is presented by Johns Hopkins Medical School, but is—get this—“developed through a strategic educational collaboration with the Institute of Applied Science & Medicine.” IASM is part of an umbrella MECC called McMahon Publishing Group, purveyor of innumerable throwaway journals like American Psychiatry News, CNS Senior Care, and Lord knows what else.

Once on the conference's website, I clicked on their “Educational Prospectus,” which provides a fascinating insight into the titanic scale of financial incentives that keep industry-funded CME so biased. This document is not meant for physicians, but rather for MECCs and drug companies who want to promote their products to impressionable psychiatrists attending the meeting.

Let’s look at this together, shall we? Call it a “guided tour of greed.”

First, go to page 2: “Educational Program.” Here, you’ll find information on the coyly named “Independently Supported Symposia”—which in less Orwellian circles is known as “Industry-Funded Symposia.”

IASM’s fee for a single, 90 minute ISS “slot” is $85,000. While this may seem excessive ($944/minute), your cost includes:

--“Exclusive support of a symposium slot” (Meaning no competition from any other drug companies trying to sell their products.)

--“Audience recruitment and session promotion” (Special placards and signage throughout the hotel designed to encourage psychiatrists to show up.)

--“Certification through Johns Hopkins University School of Medicine” (I’d love to know how much Johns Hopkins is charging IASM for this particular sell-out. I would guess somewhere in the high five figures.)

--“Registration report/summary of participant evaluations” (Ie., the names and addresses of a boatload of physicians for future promotional CME mailings.)

Now, let’s go to page 3: “Enduring Materials.” And I quote: “Based on the content presented at the live ISS, enduring material activities will be developed by the Medical Education and Communication Company (MECC) and distributed by the Institute’s educational partner, American Psychiatry News.”

For $103,000, IASM will prepare a “Special Report,” an 8-page, journal-sized monograph of approximately 4500 words with a 10-question multiple-choice post-test.

A bit steep for a measly review article, you say? But wait, there’s more!

-- "Certification of the Special Report monograph through The Johns Hopkins University School of Medicine" (I wish I could buy stock in this "Johns Hopkins" company--oh wait, it's a non-profit "university"--I forgot.)

--“Distributed in an issue of American Psychiatry News” (This is a mini-version of the supplements made infamous by Journal of Clinical Psychiatry.)

--“Online version of the Special Report monograph hosted on for 1 year from the date of release” (Yes, CME Zone, once featured on this very blog for having created a sham CME article promoting orally disintegrating alprazolam (Shwarz’ Niravan) for anxiety disorders, arguing that it is safer than SSRIs.)

--“Distribution of the Special Report monograph from American Psychiatry News exhibit booths at national conferences for 1 year from the date of release” (After all, advertising is all about repeating the message over and over again—“the more you say, the more they pay.”)

--“Inclusion in an e-mail broadcast, Zmail, announcing online availability of the enduring material” (Even more advertising? Bring it on!)

There are several other pages detailing the separate responsibilities of various “partners” (in crime?), and a crucial bullet point clarifying that your fees do not include honoraria for faculty hired guns, or for their travel, lodging, and meal expenses.

Finally, notice that since this money-making scheme is formally sponsored by Johns Hopkins, Pfizer will agree to fund it if asked—clear evidence that their recent announcement that they will not directly fund MECCs should have little impact on the bias inherent in industry-funded CME.


Anonymous said...

I read this and just want to puke, preferably on the steps of the department of psychiatry at JHH.

You know, folks, having trained near this allegedly illustrious institution of higher learning, all I can tell you is they were, and still are, one of the most egregious examples of what went wrong in psychiatry. Their pathological embrace of the biochemical model that really took hold in the late 1980's sold the wrong message. I am so glad I went to a residency program that still embraced therapy as a major element to the treatment process in my profession.

I like my alias. It represents what is right in my career. I told colleagues this would be a watershed year for psychiatry back in December. What will the next 5 months bring? Hopefully, healthy change, and ironically, sanity!?

Anonymous said...

Wow. After reading the last few posts its hard to believe that you aren't making this stuff up.

Awhile back I reached the conclusion that free CME was worth what I paid for it. But I never dreamed of how much effort went into skewing those "educational" reports.

Thanks for doing all this work.

Bernard Carroll said...

Dr. Carlat, thank you for laying out this case study so clearly. Your information confirms the model that I described over on Health Care Renewal 6 months ago. Here is what I wrote then: "The standard formula (for commercially funded CME) calls for corporate sponsorship channeled through an “unrestricted educational grant” to a medical education communications company (MECC). The MECC employs writers to prepare the “educational content,” and academic KOLs are recruited to deliver this content. The KOLs are chosen for their willingness to be “on message” for the corporate sponsor. If they go “off message” they know they will not be invited back. The talk of “unrestricted grants” is window dressing. The MECC also secures the imprimatur of a nationally accredited CME sponsor, typically an academic institution. The sponsor is paid to certify that the CME program meets the standards of the Accreditation Council on Continuing Medical Education (ACCME). Everybody turns a buck: the MECC and its staff are handsomely paid (CME is now a multi-billion dollar business); the KOLs are generously rewarded with honoraria and perquisites; the academic sponsor is well paid by the MECC; the ACCME receives dues from the academic sponsor; the audience obtains free CME credits rather than having to pay for these required educational experiences; and the corporate sponsor gets what it considers value for its marketing dollar."

Thanks to your post today, we now have a better idea just how much money is sloshing sround in the world of CME. The effect is akin to Gresham's Law -- corrupted programs and information drive out unbiased education.

Well done!

Anonymous said...

Human nature never changes. I have come to the conclusion that psychiatrists as a whole are no different than society in general.

You are not priests, by any stretch of the imagination. However, some of you are more priestly than others.

Anonymous said...

Johns Hopkins University (JHU), a beacon of hope in medicine! JHU = Just Hose Us???? Unbelievable.

Anonymous said...

The sentence that stands out for me is this: "The information presented in the ISS must provide participants with an objective viewpoint." In particular, the word "objective" because everything that follows seems to belie any possibility of being truly objective. This is all about money and who has the money? The drug companies and they have one agenda -- to sell their drugs -- not to improve the welfare of patients.