Occasionally, a piece of investigative journalism sets into motion processes that strike corrupt business practices at their core. Such an article was published yesterday in the Milwaukee Journal Sentinel, written by John Fauber and Suzanne Rust.The article is entitled “Drug firms' cash skews doctor classes: Company-funded UW courses often favor medicine, leave out side effects.” It is such a devastating indictment of the corruption inherent in drug company funding of CME that it will become required reading for all those involved in health care policy.
The University of Wisconsin has a huge program of industry funded CME. Why? This is fueled largely by George Mejicano , UW’s associate dean for continuing education. Mejicano, who was profiled by Medical Meetings magazine in 2008, was the driving force behind winning $12.3 million from Pfizer for a CME program on smoking cessation, $3.5 million of which went to UW. Pfizer, of course, markets Chantix, the new smoking cessation drug which is effective but laden with side effects, such as nausea and insomnia, and, potentially, suicidal ideation. These side effects should not necessarily dissuade doctors from prescribing a drug which may ultimately save many lives, but they should be made aware of these risks.
Unfortunately, Fauber and Rust found that the smoking cessation course produced by UW does not even mention Chantix’s side effects. The reporters asked Dr. Mejicano to comment on this and on the fact that the course did not disclose that clinical trials of Chantix excluded patients with common comorbid conditions, such as mental illness and heart disease. Here’s how he responded: “UW's Mejicano said he did not think the side effects or the people excluded from the clinical trials should have been included in the course. He said such courses are rarely comprehensive and are designed to meet selected learning objectives.”
Indeed—and this is precisely the problem with industry funding of CME. The drug companies, via the proxy of various third parties, set the agenda for medical education. That agenda does not include saying bad things about the funder's product. I commend Mejicano’s honesty for essentially admitting this, thought it was apparently an unwitting confession.
The article goes on to profile other UW CME courses, in each case showing how the content is biased in favor of the supporter’s drug. This rogues' gallery includes a course pushing Boehringer Ingelheim's Mirapex for restless leg syndrome and one hawking Bayer’s Yaz and Pfizer’s Xanax XR for premenstrual dysphoric disorder.
I wonder if the American Medical Association, that great defender of industry sponsorship of CME, will respond to this article. Perhaps they can reference it in their new and embarrassing “fact sheets” on CME, which I reviewed here.
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6 comments:
If the AMA and the rest of medicine just not get control of this nonsense, then Congress will step in. Just as has happened with conflicts of interest.
Robert Golden, the Dean of the medical school at UW Madison needs to grasp this nettle. However, he has issues of his own. He is a long time confidant of the compromised Charles Nemeroff, the poster boy for conflict of interest in academic medicine. Dr. Golden even signed a notorious letter in the Wall Street Journal in 2006 defending Dr. Nemeroff in a scandalous case of non-disclosure (the Cyberonics vagus nerve stimulator affair). Quis custodiet custodes ipsos?
A lot of the scrutiny over industry-sponsored CME has made some dramatic changes. Large companies, such as Schering-Plough, have cut funding to CME altogether and many other companies have considered following SP's lead.
It seems to me that CME ought to provide clear reviews of current medical topics, and probably should have to show up front what their search/inclusion/exclusion strategies were in producing such reviews.
It's also clear to me that doctors don't always have time or sufficient interest in adult education to produce such materials on a routine basis.
The question is, who _can_ produce these materials, and how should those efforts be funded/overseen?
If every licensed health professional had to pay a CME fee [along the lines of the tv license fee in the UK which funds the BBC], would that result in a fund large enough to fund authorized CME materials? The resulting materials might not be as glossy as those produced with pharma dollars, but the work would still get done, and the funding structure would be based firmly with the organizations supposedly in charge of assuring quality care.
[Note: I'm sure other readers can ferret out the unintended consequences of such a system. Nothing on earth is incorruptible. And I know that a literature review can only be as good and as comprehensive as the data that actually reaches publication! But I'd rather see a reward structure that makes the discipline of medicine "the client", rather than the maker of any one product.]
Perhaps in this economic climate, pharma will be forced to make cutbacks in marketing departments. That could solve everything!
Let the scientists prepare the educational information (with the help of medical writers and instructional designers, of course) and cut out the "happy story" pushers. Physicians will then learn about the benefits AND limitations of the medication.
This will work for the physicians who can negotiate gray area. For the rest, well, it can't be much worse than having them prescribe new medications willy-nilly.
I just had an inspired idea, I think ... How about just getting rid of the bloody CME?! The whole concept is so insulting.
With access to endless studies of all kinds at any moment thanks to the breathtaking vastness of the internet, why get watered down versions or translations from anyone?
The boards exams can then can just check if we do our jobs and keep up.
Thanks for your blog. Something to keep my cynicism up. Best, Jennifer
http://drbremer.blogspot.com
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