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 scienti
fic 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.
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2 comments:
“The three authors of this pseudo survey study are:
...clinical editor (that is, she ghost-writes articles “authored” by physicians) for ..., another prominent MECC.”
Dan,
I am freelance medical writer-editor who has, yes, worked for MECCs and who is, yes (surprise!), concerned about the ethical issues of medical writing. Perhaps the most important ethical issue is the unethical practice of ghostauthoring, in which the role of pharmaceutical companies in developing manuscripts for submission for publication is concealed. Typically, MECCs do the actual work. Their participation might be concealed, too.
Your description of the MECC’s clinical editor’s job, “that is, she ghost-writers article ‘authored’ by physicians, recalls two other strident and conclusion-jumping comments about ghostwriting in your blog:
1. Wednesday, July 16, 2008. Pfizer and CME: Reading the Tea Leaves. “MECC writes check to hired guns and ghost writers.”
2. Monday, July 30, 2007. Tweaking Medical Information, Courtesy of CME Zone. “If I ever decide to chuck all this idealistic stuff and start taking Pharma money, I know exactly which ghost-writer I will hire first to create my million dollar CME programs...”
Now, consider two anecdotes about two medical writer-editors left MECCs because of the MECCs’practices.
One, who has a doctorate in anatomy, get fed up with ghostwriting articles, as explained in November 2002 to The New York Times (http://tinyurl.com/652224) and to PBS’s NOW with Bill Moyers (www.pbs.org/now/transcript/transcript_scienceforsale.html). The writer turned to teaching high school biology.
Another, who has a doctorate in pharmacy, left a MECC after about 1 year to work as an editor at a pharmacy journal. This writer-editor become disillusioned about the MECC’s ghosting. (Reference: Mohassel MR. Medical education and communication companies: how ideal a fit for pharmacists? Am J Health Syst Pharm. 2003 Sep 15;60(18):1837).
Furthermore, the issue of ghosting is an active topic on AMWA’s members-only e-mail discussion lists.
And as for the MECCs, things are changing. Did you know that MECC presidents organize and lead sessions on medical writing ethics at the annual conference of the American Medical Writers Association (AMWA; www.amwa.org), the premier organization for manuscript writers and editors?
Finally, you’ll need to decide for yourself if bashing medical writers and editors who work for MECCs contributes to the tone of your blog. Stridency, especially based on shaky generalizations drawn from jumping to conclusions, distracts from the issues and is a turnoff. Given your extensive coverage of psychiatry department chairs who are on the money, would you conclude that all such chairs are rolling in the dough?
Michael,
I certainly agree that there are good and bad apples in the medical writing industry, the psychiatry chairman industry, and any other endeavor. I think ghost-writing is much less objectionable when it is not part of promotional material. For example, many fine medical books for consumers are written through collaborations with ghostwriters. But I cannot accept that ghostwriting in industry-funded CME is ever acceptable, because it represents an inherent deception. Companies know very well that their marketing messages will appear more legitimate and believable if they appear to come out of the mouths, or the pens, of KOLs. But the KOLs don't have the time to produce all this material, so medical writers are hired to do so. I see this as collusion, and I will continue to bash this practice, no matter how "strident" it sounds.
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