As pressure continues to build on various medical organizations to curb industry funding of CME, the companies and their MECC minions (MECC = Medical Education Communication Company) continue to churn out infomercials with the ACCME stamp of approval.
The sleazy "MECC of the Month" is the Delaware Media Group. Here is how they describe themselves on their home page:
“Delaware Media Group
Custom Health Care Communications
Delaware Media Group (DMG) is a fast-growing health care communications/education company that specializes in providing customized communications vehicles to suit your marketing and continuing education needs and goals and enhance your relationships with key customers in the health care community.”
The fact that DMG pairs “marketing” with “continuing education needs” in their promotional material pretty much says it all. This is an outfit whose raison d’etre is to help drug companies sell their products.
Their major marketing vehicle is a pseudo-journal called “Counseling Points” . Each issue focuses on a different topic of interest to the supporting drug company. Who actually creates the content is always confusing, however. For example, I was just sent the June 2010 issue of Counseling Points, entitled "Challenges in Schizophrenia: Overcoming Nonadherence and Preventing Relapse in Schizophrenia."
In the increasingly rare real world of medical education (doctors honestly imparting their clinical wisdom to other doctors), there is an “article” and there is an “author.” The author is an academic doctor who came up with the idea for the article, wrote it, and sent it somewhere for publication. You can trust the content because you know who wrote it and why.
But in the world of industry-funded CME, articles become “activities,” and a basic 9 page piece on the treatment of schizophrenia suddenly requires a whole army of staff: three “faculty” (in this case, three psychiatrists--Christoph Correll, John Kane, and John Lauriello), nine “planners” and “managers” (a smattering of nurses, pharmacists, medical writers, and logistics coordinators), two “co-sponsors” (the “Annenberg Center for Health Sciences” and Delaware Media Group), one collaborator (“Postgraduate Institute for Medicine”), and of course, propping up the entire charade, the commercial supporter, in this case Janssen.
So who actually wrote the darn thing, you might ask? It’s impossible to say in this musical chairs game of “content creation.”
Speaking of content, what does this article have to say? Very little that is surprising. The main points are the following:
1. Schizophrenic patients often don’t take their medications, and there are a bunch of reasons why.
2. When schizophrenic patients stop taking their medications, they get worse.
3. Here are some helpful tips on how to keep your schizophrenic patients on their medications. This section begins with a half page on psychoeducation and cognitive behavioral therapy, followed by two beefy pages on long-acting injectable antipsychotics. And guess what? The major manufacturer of these drugs happens to be Janssen, which funded this article. Janssen markets both Risperdal Consta and Invega Sustenna.
I know this topic well. I read the entire article, and I found nothing in it that was inaccurate. Nor did I find any blatantly biased statements about Risperdal Consta or Invega Sustenna being better than its competitors. The bias is much more subtle. For example, they discuss their arch-rival Zyprexa Relprevv only once, and here’s what they have to say: “As in the presumed cause of olanzapine palmoate postinjection delirium and sedation, there is always a chance that an injected drug can reach the venous space instead of the muscle.”
Wow—there's a portrait of olanzapine that doesn’t exactly make me want to rush out and start prescribing it. But here's what they left unmentioned: This side effect occurs in only 0.07% of injections (see the reference here). That means only 7 out of 10,000 injections, making it a very rare side effect. This additional information would have been a helpful clarification. But it wouldn't have made its competitor look quite as lame--which is why they left it out.
No, there is nothing inaccurate in the article. Just like drug company ads in journals, everything is carefully vetted to be completely accurate, but, just like advertisements, it is just as carefully crafted to increase prescriptions of the company’s products.
And this is why relying on pharmaceutical companies to pay for our CME is such a dangerous game--there is no longer any difference between advertisement and education.