Friday, July 31, 2009

Senate CME Hearing: Impressions, More Links

There's no question that the recent Senate hearing on CME was stacked against industry funding of CME, but that's because from the standpoint of the American public and Congress, the practice is slimy and wrong.

Senator Mel Martinez, a republican from Florida, summed up the mood best with his perplexed question (I'm paraphrasing here): "Wouldn't it just be better if doctors paid for their own continuing medical education?" As a lawyer, he said, he always paid for his own CLE (continuing legal education) and he was never paid to give CLE lectures.

To those of us who have lived and breathed this issue for years, his question came across as innocent, but in fact it hit the obvious point, and surely summarized the view of most Americans.

Tom Stossel, to his credit, came out swinging in a ring where he was badly outnumbered, but as he often does, he conflated two issues: the remarkable advances in medicine over the past few decades and industry funding of CME. The two are not related. We've had advances in medicine because of great science and appropriate interactions between doctors and industry--bona fide relationships based on developing products and conducting clinical trials. None of these relationships would be threatened in any way by the Physician Payments Sunshine Act or by the IOM's proposal to greatly scale back industry funding of CME.

My favorite moment of the hearing was when Senator Al Franken directly confronted Stossel, saying (again, I'm paraphrasing): "You seem to draw a lot of conclusions from anecdotes of people who have benefited from modern medicine. Medicine is a lot better now than when we were kids, but that doesn't mean that industry should fund CME."

Dr. Kopelow's comments were disappointing in the extreme. He repeated a single refrain, saying, in essence: "There is no problem with bias in CME. We are doing our job well. ACCME is the firewall between promotion and education." C'mon Murray! You know what's going on. You've seen the many, many letters of complaint reporting biased programs. In fact, you reprimanded one company for bias within the last few months--I know, because the reprimand was based on my letter. It only took you about two years to issue your decision. I won't mention the specifics in this blog because I promised you I wouldn't.

I liked Lew Morris's comments. He's the General Counsel, U.S. Department of Health and Human Services, Office of the Inspector General, and so he's pretty influential. He wants to set up "independent CME grant organizations" that would pool industry funds and divvy them out in ways that don't promote specific treatments or lucrative disease categories. Good luck to him. He admits that drug companies have shown zero interest in parking any of their so-called "unrestricted educational grants" in such organizations. He alluded to one that was set up by a surgical association. Its current budget: $0.00. Clearly, companies will only fund CME if they see a promotional advantage.


The Senate Aging Committee website has now posted links to all the written testimony, including my testimony (I am erroneously identified as being from the Cleveland Clinic--apparently they mixed me up with Steve Nissen and I am flattered!), as well as testimony from Pharmed Out (Dr. Adrian Fugh-Berman), and from a series of organizations that have vested interests in keeping things as they are, including the University of Wisconsin, PhRMA, AdvaMed, and Merck.


Anonymous said...

Is it odd that Senator Kohl would hold a hearing on CME, when his bill - the Physician Payments Sunshine Act - won't have any effect on industry-funded CME and won't create any new transparency around industry-funding of doctors who give industry-funded CME talks?

Michael S. Altus, PhD, ELS said...

Medical Research and Education: Higher Learning or Higher Earning?
July 29, 2009

The United States Senate Special Committee on Aging’s news release about the hearing, “Kohl Hearing Considers Effects of Billions in Drug, Device Funding on Medical Education in America” is available at ( (Interesting slant in the headline—“Kohl hearing” rather than “Senate hearing”)

The hearing webcast is available at (, “Click here.”

Statements of committee members and written testimony from the witnesses who testified at athe hearing are available at (

Submitted testimony from those who did not testify is available at “Kohl Hearing” (

Now, all of this is very interesting, but what does it have to do with medical writers?

Written Testimony Submitted by Thomas P. Stossel, MD, to the United States Senate Special Committee on Aging, July 28, 2009
If physicians or researchers allow themselves to be designated authors of papers written by professional writers without having participated in the research or contributed in some other way to the article – so-called – “honorary” authorship, low value is manifest, and this practice should be eliminated. Nevertheless, professional writers appropriately acknowledged can help render publications more timely and readable.

I prefer "guest authorship" ( to “honorary authorship”, but I agree that the practice should be eliminated. Plus I agree that acknowledged medical writers can make a worthwhile contribution. (Disclosure: I am a professional medical writer.)


Michael S. Altus, PhD, ELS
Intensive Care Communications, Inc.®
Biomedical Writing and Editing