Deception has, unfortunately, become the standard operating procedure in the world of continuing medical education. Charles Nemeroff and his band of Merry Men—all of whom made millions promoting drugs in the guise of medical education—are the tip of the iceberg.
In the latest assault on the public’s trust, we have a new journal, CE Measure. The journal bills itself as “the first peer-reviewed journal dedicated specifically to the art and science of healthcare educational outcomes measurement.” Sounds promising.
The current issue contains an article entitled “The Impact of Commercial Support on Continuing Medical Education: The Physician’s Perspective.”
At first blush, it seems to be a conventional peer-reviewed scientific article reporting data derived from a physician questionnaire. The bottom-line, according the three authors, is that “among the 906 respondents, more than 80% disagreed with the proposition that all commercial support of CME should be eliminated.”
But who were these physicians, and how were they selected? The one paragraph describing the study’s methodology says only that these physicians took CME courses in 2006 and 2007. We are not told what kinds of courses. Were they industry-sponsored? Were they live conferences, web-based programs, or articles? Were meals provided? What was their subject? What were the specialties of the participants? A majority of doctors did not respond to the survey—how did they differ from those who did respond? These are all basic questions required to interpret the results of the study, yet the authors do not even mention these issues.
In all peer-reviewed scientific papers, editors require a discussion of the limitations of the research. Especially in the political football of CME research, such a discussion is crucial. For example, past surveys have shown that when doctors are asked for their opinions about commercial funding, those who are surveyed after attending an unsponsored course are against industry CME, while those surveyed after an industry-sponsored course support industry funding (Mueller, P. S., Hook, C. C., & Litin, S. C. (2007). Physician preferences and attitudes regarding industry support of CME programs. The American Journal of Medicine, 120(3), 281-285.) This is intuitive: if you give doctors the gift of a meal and a day of free education, then you ask them if they would they would like to receive such gifts in the future, they are likely to say “yes.” And if you decide to include only these doctors in your survey, you will probably receive an overwhelming response in support of industry-sponsored CME. But this possibility is never broached in the discussion.
The authors apparently felt that an objective scientific discussion was less important than publishing the verbatim comments of some of the physicians surveyed. In a section entitled “In Their Own Words”, the authors reproduced several mini-rants from doctors who are outraged at the notion that they might have to pay for their own education.
For example, here is what one of their respondents had to say: “Dumbing down physicians! Disclosure and disclaimers are sufficient caveats. According to this idea, medical journals should not accept advertising from pharmaceutical companies. I would like to read AMA’s and NEJM’s explanation of why it’s OK for them to accept 4 color full page ads from Big Pharma. Docs could actually be fooled into using bad drugs. Wow, we’re such boobs. We (docs) need to be protected by academic elitists.”
This physician apparently confuses industry-sponsored CME with drug ads—and who can blame him or her?
After reading the article, I decided to do some research on this “peer-reviewed” journal. As it turns out, I was shocked—just shocked—to discover that CE Measure is a sham mouthpiece for the MECC industry. In fact, here is how this journal is produced:
1. It is funded by seven drug companies: Genentech, Pfizer, Sanofi Aventis, Alcon, Janssen, Sepracor, and Endo. No, these companies have placed no ads in the journal, so there is no pretense of a firewall between commercial influence and editorial content. The funding is simply raw cash given to the publisher. How is this different from NEJM’s “4 color full page ads” railed against by the physician quoted in the article? Legitimate journals make the following deal with advertisers: “You pay us a bunch of money, and in return we’ll publish your ads. But that’s all you get for your money. You can’t influence the content of our articles.” At least that’s the theory—the effectiveness of the firewall varies from journal to journal. In the case of CE Measure, the deal is different: “You pay us a bunch of money, and in return we won’t give you ads; instead, we’ll give you articles whose content will benefit the marketing aims of your company.”
2. The publisher is listed as “Carden Jennings Publishing (CJP).” Their medical publishing division specializes in industry-funded CME. In other words, CE Measure is published by a MECC.
3. The editor is “Robert F. Orsetti, MA, FACME, CCMEP.” No affiliation is listed, and the many initials after his name imply the respectability of academia. However, an internet search reveals that he is the Executive Vice President of a company called “Educational Measures,” whose life-blood is industry-sponsored CME.
4. The three authors of this pseudo survey study are:
--Sandy Bihlmeyer, MEd, CCMEP, Director of CME for Primary Care Network, a MECC producing dozens of industry-funded programs yearly.
--Curtis P. Schreiber, MD, Vice President of Medical Programs for the same company, Primary Care Network.
--Sally Farrand, clinical editor (that is, she ghost-writes articles “authored” by physicians) for Pri-med, another prominent MECC.
The sad thing is that some of the members of the journal’s editorial board are people I know and respect. They were asked to put their names on a new publication, but they didn’t realize what they were getting into. I hope they will resign before their reputations get dragged down to the level of CE Measure.