Sunday, April 17, 2011

"Performance Improvement" CME, Brought To You By Medscape and Eli Lilly

Performance Improvement CME has become all the rage in the world of continuing medical education. Otherwise known as PI CME, it is being touted by the AMA as the next big thing in medical education. You can read an AMA white paper about it here.

Not all medical specialty organizations actually require that physicians complete PI CME, but they are moving toward this. The American Board of Psychiatry and Neurology now requires something similar, which they call "self-assessment" CME, and it requires a robust program of medical learning to doctors, along with a minimum of 100 CME questions. There's more to it than that--I had to learn about it in order to get Carlat Publishing approved for it.

It's fine with me, thought it is another annoying hurdle for CME providers and for doctors, but maybe in the end it will force doctors to keep their knowledge more up to date. The problem is that there are no regulations regarding who can support these new and elaborate programs. Obviously, as you can see from the screen shot above, or by following this link, Medscape is already exploiting commercial funding. This is a PI CME program called "Diagnosis and Treatment of Major Depression: Performance Improvement." It is funded by Eli Lilly, maker of the antidepressant Cymbalta. I haven't gone through the program yet, but I'm willing to bet that there will be a lot talk about pain in depression. 

I hope someone out there can investigate this Lilly/Medscape joint endeavor to see whether it is biased or unbiased. Let me know your thoughts!


pacificpsych said...

Just doing it, thinking it's required for something though not sure what. It seems that TALKING and LISTENING are worthless - only standardized scales are good.

Maybe not supposed to copy answers, so far it seems to be pushing rating scales, along with the usual one size fits all psychiatric dogma. No overt pushing of medications so far, but rating scales are to me so wrong that it's just another form of indoctrination into the machine. They are closely tied of course to bio-psychiatry.

That's my take on the first part.

Daniel Carlat said...

Pacific psych--thanks for slogging through the first part. I'm not surprised that they push rating scales. Not that there's anything inherently wrong with them, many psychiatrists use them to help guide their treatment. Personally, I have not found them useful, since I ask the relevant questions during the interview. I suspect that the industry funded PI activities will tend to push scales because they want to make sure that an "official" major depressive disorder gets diagnosed. Often, the scales will spit out a positive diagnosis, but the severity and the treatment implications are unclear. A Lilly-funded activity will likely highlight studies endorsing a menu-driven approach, ie., if the score is X, use medications or therapy, and there will be lengthy descriptions of medications, with a lot of Cymbalta-friendly advice mixed in. Just guessing!

Asslete said...

The bias is still heavily weighted towards meds. One of the questions was along the lines of"

"For patients with MILD depression what is the best initial treatment recommendation:

1. Psychotherapy alone
2. Antidepressant alone
3. Either psychotherapy or an antidepressant
4. Both psychotherapy and an antidepressant"

I feel the best initial option is Psychotherapy alone (and if that fails, then meds)...but the "best" option according to the program was either meds or talk therapy.

pacificpsych said...

Actually there was no mention of cymbalta. Or pain. And to my surprise the 'correct' answer for how to treat moderate depression was medications OR psychotherapy.

To say it was reductionistic and promoted a one size fits all is an understatement. There was one question whose answers which went something like:

1) I use rating scales every session to evaluate severity.
2) I do nothing.

There was a third option which I can't remember, but it was not a reasonable option. So it's rating scales or nothing.

Since we know Pharma doesn't do anything for the good of mankind, there must be a reason for them to fund this. Your point about menu driven was very true. But there was no overt marketing here of drugs at all.

David Healy has explained very well the marketing of illness, for example depression in Japan, as a way to create a need for medications. We don't need to talk about Bipolar, do we. We know that marketing can be devious and subtle. This activity promoted a one size fits all, I guess that's it. Or to put it differently, it surprisingly didn't promote a humanistic, deep, complex view of suffering and treatment. /sarcasm. If there are more ties between Eli Lilly and rating scales I don't know about them.

Joel Hassman, MD said...

This Forest Labs and debarment issue should be a story being covered by health care sites, especially here with the issue involving inproprieties with Lexapro.

You worry about CMEs being manipulated by big pharma? How about Obamacare manipulating who participates in this disgusting legislation that will ruin psychiatry?

Not by drug issues, but sheer control over who practices and what interventions can be used. This is the story that is now coming to attention.

Surviving said...

Maybe the CME giving doctors tips about how to manipulate patients into staying on antidepressants unnecessarily for years -- "maintenance" -- has topped out in returns.