Tuesday, September 14, 2010

Harvard's Top Neurologist Just Says "No" to Commercial CME

In a piece of extraordinarily good news for those of us promoting industry-free CME, one of Harvard's top neurologists, Martin Samuels, announced a new company, Lighthouse Learning, that will refuse any commercial funding for continuing medical education courses.

The Boston Globe broke the story in this article on their front page, which is in itself significant. It means that mainstream journalists understand that the funding of medical education is no longer an arcane topic that is of interest only to a few insiders.

The Globe's Liz Kowalczik quotes Dr. Samuels thusly:

“Doctors have lost confidence in [continuing medical education] and the public has lost confidence,’’ said Samuels, who sees patients at Brigham and Women’s Hospital, where he heads the neurology division. “The feeling is that everything is tainted. We simply must have a new way of doing this.’’

Dr. Samuels' statement is particularly convincing because he used to be involved in the very industry-funded system that he is now spurning. Until recently, Samuels was the head of the neurology course of Pri-Med, an industry-funded MECC that puts on well-attended CME courses throughout the country. (Here's a link to their upcoming course in Boston). In January 2008, I blogged about Dr. Samuels' lecture at an ethics meeting at Harvard Medical School. Clearly, he was already ambivalent about industry funding of CME, calling for the the abolition of industry-sponsored satellite symposia at major medical meetings, while still defending the ability of Pri-Med to maintain a firewall between promotion and education. Evidently, his experiences with Pri-Med since then have proven to him that such a firewall is easily breached.

I'm going to assume that M/C Communications, the parent company of Pri-Med, is not terribly happy about this turn of events. According to the Globe, "
M/C Communications said its model allows it to reach thousands of doctors with affordable programs. " Talk about a lame defense. In not even addressing the central issue here--that industry funding inevitably biases CME--M/C has essentially admitted that they are a marketing company. If they had been honest they would have said that "its model allows it to promote the sponsor's products to thousands of doctors with affordable programs."

Here is Lighthouse Learning's official press release announcing its launch.


Anonymous said...

Do we really need this, when we already have the MGH Academy providing quality education to all doctors? Check out their website:


Uma said...

lets hope the vicious circle is completing itself and the best brains put the interests of patients above all else, setting an example for others to follow!

SteveM said...

Re: "Dr. Samuels' statement is particularly convincing because he used to be involved in the very industry-funded system that he is now spurning."

Danny, maybe Dr. Samuels is just an opportunist who put his thumb up to see which way the economic wind is blowing? I.e., he's knows Pharma sponsored CME is dying, so is following the money. Keep in mind that Dr. Samuels' "particularly convincing statement" is also a marketing pitch for Lighthouse. What took him so long?

Nothing wrong with that BTW. It's a free country. But I don't think you can impute anything about his character given his financial association with Lighthouse.

New horse ridden by the same jockey.

Anonymous said...

How could you as a psychiatrist take so simplistic an approach as to assume that the elimination of industry funding eliminates bias? One need not be a psychiatrist to know that everyone harbors some kind of bias and sometimes those biases can be more damaging than the ones you claim to be insinuated through commercial support.
And for those who take the approach that industry funding creates subtle levels of bias which can't be readily discerned then consider this. If Lighthouse uses speakers like Steve Nissen- who used to accept industry support- then who is to say that these speakers, though renouncing their former affiliations, don't still harbor a deep seated bias that will emerge at some key point in their presentations?

Industry supported CME needs to be closely watched to avoid abuses. But as long as pharma is in the business of creating cures for disease there will always be an alignment between the interests of pharma, physicians, government and the public. Until you admit that fact you are on the wrong path.

Anonymous said...

Yeah, that's how I felt, too. I'm just being asked to bend over in a different direction.

Dr John said...

I agree that it will be very hard if not impossible to remove the taint of big pharma but it is not impossible. I used to make 2k a pop doing talks for GSK before I realized it was not only immoral but I did not even believe the bs I was being asked to spread. I quit in the middle of it when I could have still made a lot of money and not while the gravy train was being pulled out from under me. It is possible for people to change. I was motivated by my own sense of right and wrong and the awakening that I had that what I was doing was immoral. Others may find motivation else ware. Taking pharma industry funding out of cme will
help those who are having trouble seeing for themselves
even if it does not make it all perfect. It will take a
generation however to undo the harm this has had on
Med. ed. and much deeper changes but this is a start. If those of you on this blog are smart enough to have your bs detectors turned to 11 maybe some others are too.

SteveM said...

Yeow! The web reference from Anonymous #1 is amazing.

American elites use intelligence as a proxy for wisdom. So ethically challenged nitwits from Harvard get a pass on all kinds of flavors of feckless stupidity apart from SAT scores.

MGH heals a lot bodies while simultaneously corrupting a lot of souls...

pacificpsych said...

This is good.

I wonder what non-pharma sponsored psychiatrist they could possibly find.

About the topic in general, not about Samuels, sometimes you gotta dig a bit deeper.

On Huff today classic disease mongering and distortion "so many kids are mentally ill out there and no it's not their parents fault they need help and no kids are not overmedicated" by a psychiatrist who says he doesn't take money from Pharma. O..K... http://www.huffingtonpost.com/dr-harold-koplewicz/7-myths-in-child-mental-h_b_692590.html http://huff.to/a3akqI

Several years ago disturbing ad campaign in NYC, by him http://bit.ly/d73H6N http://www.furiousseasons.com/archives/2007/12/many_angry_at_childhood_mental_illness_hostage_ad_campaign_1.html run by BBDO ad agency, which has extensive ties to Pharma, for example, a 2008 campaign: http://pharmexec.findpharma.com/pharmexec/article/articleDetail.jsp?id=500914 http://bit.ly/bh6mXS

And you did notice in the furious seasons link that he was one of the authors of a paxil study that claimed it works in teens when it doesn't..

But what do I know, huh...the guy probably just wants to "increase awareness blah blah".

1boringoldman said...

It would be easy to find holes in Samuel's approach - ways PHARMA might get around his safeguards. But that would miss the point. All nets have "holes," and in this case the fish he’s trying to catch are pretty big. He’d catch Dr. Charles Nemeroff in a blue second, as well as the egregious CME violators known as FOC’s [friends of Charlie's]. And he’d avoid a lot of softer ways industry has introduced bias into CME.

I vote we give him credit for the effort, and keep close eyes on the Curriculum when it's available...

SteveM said...

Re: 1boringoldman

The point I made above is that the professional probity of the Lighthouse business model and those of its agents may be completely independent. Mussolini made the trains run on time.

Dr. Samuels could have rejected the Pharma sponsored CME model years ago like Dr. Carlat did. But he didn't. He only did it when an alternative revenue opportunity presented itself.

It would not surprise me if Charley Nemeroff eventually has the same kind of epiphany and gets hired by a Lighthouse type outfit. And like Dr. Samuels, Nemeroff will claim the need for a "new way" of CME.

But Nemeroff is no Chuck Colson in prison. Charley won't be doing that because he will have raised his ethical standards. He'll do it for the money. That's it. The money.

The important subtext to all of this is how Samuels's and Nemeroff's physician colleagues still afford those guys all kinds of deference and respect.

That's the real indictment. Not Nemeroff or Schatzberg or Biederman anymore. Their sins of commission have been laid out. It is the sins of omission by their fellow psychiatrist enablers who indirectly sustain what psychiatry has become.

SteveM said...

Not to beat a not dead horse of medical-Leviathan perversity. But here is a snippet from the MGH bio of Dr. Joseph Biederman:

As of March 2007, Dr. Biederman has been ranked as the second highest producer of high-impact papers in psychiatry overall throughout the world with 235 papers cited a total of 7048 times over the past 10 years as determined by the Institute for Scientific Information (ISI). The same organization ranked Dr. Biederman at #1 in terms of total citations to his papers published on ADD/ADHD in the past decade. Dr. Biederman's work is supported by multiple federal and pharmaceutical industry grants.

Biederman has gamed clinical research since whenever? Yet MGH lauds the guy's production? Funded by Pharma industry grants? Amazing...

Danny, pinch me. Or punch me in the mouth so that I know I'm not dreaming...or nightmaring...or something...

P.S. And how many psychiatrists would not hop on top of an offer from MGH like white on rice? Even knowing it various contractual understandings with Mephistopheles?

Joel Hassman, MD said...

So what, re Biederman!? Life is about quality, not quantity. We work in a profession that judges people by the number of pages to their CV, not what they have legimately done of integrity and responsibility?

Again, a reflection of what is the basis to the APA and their cronies, not what real patients and colleagues are looking for in patient care in the "trenches". And just gives ammunition to those who passionately dislike our profession!

Money, power, and prestige are the biggest addictions in this culture. Bank on it!

1boringoldman said...

Re: SteveM
"That's the real indictment. Not Nemeroff or Schatzberg or Biederman anymore. Their sins of commission have been laid out. It is the sins of omission by their fellow psychiatrist enablers who indirectly sustain what psychiatry has become."

Point well made and taken. As is your earlier comment, "Keep in mind that Dr. Samuels' 'particularly convincing statement' is also a marketing pitch for Lighthouse. What took him so long?"

Still, the final arbiter is in the Curriculum they offer. Will it be more "breakthrough" drug talks, or will they aim for what Joel Hassman mentions - what "real patients and colleagues are looking for in patient care in the 'trenches'." If, as you suggest, Lighthouse is just another way to make money from CME, it's no real improvement. If it's actual broad "back to basics" education - more power to them...

SteveM said...

Re: 1boringoldman again

I'm focusing on the characters and their motivations not the CME itself. The Lighthouse content may actually be fortuitously objective and above board.

And Dr. Samuels may be a rank opportunist like a gangster who flips for a better deal. A corrupted character is a corrupted character even when he's turned to support a legitimate cause.

BTW, I suggested in an earlier Carlat posting that the psychiatrists who were going to attend the Georgia psychiatric conference in August should get up and walk out en masse when Dr. Nemeroff was introduced to speak. A simple statement of peer indignation.

And of course they didn't. So fellow psychiatrists again implicitly signed themselves up as Charley's fellow travelers. Whether they intended to or not. More little sins of omission.

You guys need a Jeremiah...

Dr John said...

It's hard to even imagine CME that is not tainted by pharma in this field just because pharma has tainted so much research for so long.

The fact is there have been no real advancements in psychiatry to talk about even if you buy into psychotherapy as a technology.

Reading psychiatric journals reminds me of going to the gym and reading muscle-head magazines in between sets. I can pick up a copy printed in 1980 or one from 2010 and they read exactly the same except for the leg warmers and big hair. Psychiatry has advanced about as much as muscle building. Take out the drugs and you got mostly flab in both.

...... said...

I like how taking drug money and then somehow having an epiphany about ethics makes one more ethical and credible than those of us who have never taken drug money. In fact, we're not even mentioned.

Anonymous said...

I highly recommend Bob Whitaker's book, Anatomy of an Epidemic to you and your readers. Research gathered therein shows evidence corroborating parts of your perspective. respectfully, LouisaP, psychotherapist, Santa Fe, NM