Tuesday, March 10, 2009

Janssen, Dr. Weiden, and the Future of Promotional CME

Industry funding of accredited CME is on its way into the dustbin of medical history, but what's next? Recently, my mailbox has been flooded by letters from a consortium including Janssen Pharmaceuticals, PV Update Publishing, and Peter Weiden, a professor of psychiatry at University of Illinois at Chicago.

The letters bear the return address of PV Update Publishing, and include teaser copy such as "A message from Peter J. Weiden, MD. See inside for details." A letter inside (read the web version here) bears Dr. Weiden's photo and quotes him saying things like "Partial medication adherence can make managing patients with schizophrenia problematic." It looks like your typical phony industry-sponsored CME, but when you check the fine print, you read:

"This promotional educational activity is brought to you by Janssen®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. and is not certified for continuing medical education. The speaker is presenting on behalf of Janssen® and must present information in compliance with FDA requirements applicable to Janssen®."

In other words, this is not CME, but promotion. Dr. Weiden is hired directly by Janssen to expound on the benefits of Risperdal Consta.

Is this the kind of promotional education that will replace industry sponsored CME? Probably. It's something I feel a little bit better about. It's honest. It's clearly advertising. It doesn't put Dr. Weiden in the awkward position of trying to defend the integrity of a supposedly academic article that is really advertising, as he had to in this exchange with me here (J Clin Psychiatry, June 2008, page 1020-1021, subscription required for access).

This is analogous to the "product theaters" that I predict will gradually replace industry-supported symposia at medical meetings.

Let the drug companies advertise their wares transparently, just like any other type of company. And keep CME pure.


Anonymous said...

Hi Danny-

I agree with you that this (advertising labeled as advertising) seems like a more honest approach for companies to get their messages out (rather that hiding behind CME). One issue that I did not see raised is the fact that a number of academic institutions have started to forbid their faculty from participating in pharmaceutical marketing and advertising activities, which will limit academic involvement in these things. Further, a few CME providers (such as ours) will no longer allow speakers who function in advertising or marketing activities (eg, company speakers' bureaus) to participate in their CME activities. This means that speakers need to make a choice to be a legitimate CME educator or company spokesperson.

Anonymous said...

How can DMJ make a statement like that without clarification? Each pharmaceutical company has different internal rules for "speakers' bureaus." This department is often not budgeted under "advertising or marketing" and, thus, these physicians would be deemed (under this writer's scenario) "legitimate" no matter how many company talks they gave.

Not to mention that the minute DMJ's company received drug funding, and, in turn, payed the "legitimate" physician they hire, that speaker would then have received marketing funds and would no longer be a "CME Educator." Are you saying that each speaker can only make one talk? I doubt it. This looks like smoke and mirrors. Please explain further. My name is Charles Nemeroff, for example. I am NOT on the Speaker's Bureau of the drug company that's funded your company to put on CME programming. Will you hire me and if not, why not? I fit the criteria you just layed out?

Anonymous said...


I'm not sure what clarification you need, but will attempt to respond.

In terms of company speakers' bureaus, these activities are considered promotion regardless of what branch of the company (or its agent) budgets for it. What makes it classified as promotion (by FDA) is that the company has selected the topic, venue(s), and the speakers who will be part of the bureau. It is something in the full control of the company and the company is bound to follow FDA regulations in terms of what is said (re, on label discussions, etc). Typically, the company provides a speaker training and a slide set that the speaker is supposed to use. Thus, these physicians are deemed company spokespeople and if fact not eligible to speak at one of our CME events.

On the second point, when our organization (we are a not-for-profit organization, not a company) receives pharma funding, we have structures and procedures in place (including ACCME Standards) to ensure that the funding is used to support the CME with no influence from the funder. As the CME provider, we are in complete control of the activity (eg, needs assessment, agenda development, venue selection, speaker selection) and can keep it independent of any company marketing objectives. So any speaker we include would not have received marketing funds from the company, or in any way be trained in a marketing message or controlled by the company (as is the case with company speakers' bureaus).

To answer your next question, I can't see anything in my response that implies each speaker can give only 1 talk. Rather, with our organization and others, the individual physician has to choose to either be a company spokesperson (eg, participate in company speakers' bureaus) or a speaker for our CME. They cannot do both types of talks.

And on your example, Dr Nemeroff. Our policy is to exclude from our activities any speaker who is involved with company marketing or promotion (any company, by the way, not just a company that may support of activity). That does not mean that we include anyone who is not on a speakers bureau or otherwise acting to promote or market commercial products. We use many other concurrent methods to assess a potential speakers' independence and ability to deliver an unbiased talk. There are many other issues that would exclude you, Dr Nemeroff, from participating in one of our activities. Similarly, regardless of whether he is on a speakers' bureau, Dr Weiden mentioned in this post would not be eligible to participate in one of our activities because of his role in the Janssen promotional article (advertorial) described.

In all, I think this is a positive direction toward desperately needed separation of promotion from independent education.

Anonymous said...

Thank you for your thoughtful response, DMJ.