In Industry CME, $85,000 buys you 90 minutes, $103,000 buys one article

I recently received an e-mail inviting me to register for a big psychiatry conference in New York City. Called the “Third Annual American Conference on Psychiatric Disorders,” it is presented by Johns Hopkins Medical School, but is—get this—“developed through a strategic educational collaboration with the Institute of Applied Science & Medicine.” IASM is part of an umbrella MECC called McMahon Publishing Group, purveyor of innumerable throwaway journals like American Psychiatry News, CNS Senior Care, and Lord knows what else.

Once on the conference's website, I clicked on their “Educational Prospectus,” which provides a fascinating insight into the titanic scale of financial incentives that keep industry-funded CME so biased. This document is not meant for physicians, but rather for MECCs and drug companies who want to promote their products to impressionable psychiatrists attending the meeting.

Let’s look at this together, shall we? Call it a “guided tour of greed.”

First, go to page 2: “Educational Program.” Here, you’ll find information on the coyly named “Independently Supported Symposia”—which in less Orwellian circles is known as “Industry-Funded Symposia.”

IASM’s fee for a single, 90 minute ISS “slot” is $85,000. While this may seem excessive ($944/minute), your cost includes:

--“Exclusive support of a symposium slot” (Meaning no competition from any other drug companies trying to sell their products.)

--“Audience recruitment and session promotion” (Special placards and signage throughout the hotel designed to encourage psychiatrists to show up.)

--“Certification through Johns Hopkins University School of Medicine” (I’d love to know how much Johns Hopkins is charging IASM for this particular sell-out. I would guess somewhere in the high five figures.)

--“Registration report/summary of participant evaluations” (Ie., the names and addresses of a boatload of physicians for future promotional CME mailings.)

Now, let’s go to page 3: “Enduring Materials.” And I quote: “Based on the content presented at the live ISS, enduring material activities will be developed by the Medical Education and Communication Company (MECC) and distributed by the Institute’s educational partner, American Psychiatry News.”

For $103,000, IASM will prepare a “Special Report,” an 8-page, journal-sized monograph of approximately 4500 words with a 10-question multiple-choice post-test.

A bit steep for a measly review article, you say? But wait, there’s more!

-- "Certification of the Special Report monograph through The Johns Hopkins University School of Medicine" (I wish I could buy stock in this "Johns Hopkins" company--oh wait, it's a non-profit "university"--I forgot.)

--“Distributed in an issue of American Psychiatry News” (This is a mini-version of the supplements made infamous by Journal of Clinical Psychiatry.)

--“Online version of the Special Report monograph hosted on CMEZone.com for 1 year from the date of release” (Yes, CME Zone, once featured on this very blog for having created a sham CME article promoting orally disintegrating alprazolam (Shwarz’ Niravan) for anxiety disorders, arguing that it is safer than SSRIs.)

--“Distribution of the Special Report monograph from American Psychiatry News exhibit booths at national conferences for 1 year from the date of release” (After all, advertising is all about repeating the message over and over again—“the more you say, the more they pay.”)

--“Inclusion in an e-mail broadcast, Zmail, announcing online availability of the enduring material” (Even more advertising? Bring it on!)

There are several other pages detailing the separate responsibilities of various “partners” (in crime?), and a crucial bullet point clarifying that your fees do not include honoraria for faculty hired guns, or for their travel, lodging, and meal expenses.

Finally, notice that since this money-making scheme is formally sponsored by Johns Hopkins, Pfizer will agree to fund it if asked—clear evidence that their recent announcement that they will not directly fund MECCs should have little impact on the bias inherent in industry-funded CME.

Tweaking Medical Information, Courtesy of CME Zone

If I ever decide to chuck all this idealistic stuff and start taking Pharma money, I know exactly which ghost-writer I will hire first to create my million dollar CME programs: the genius who wrote a hopelessly biased tract for CME Zone called "Recognition and Treatment of Anxiety Disorders in the Primary Care Setting." I have never seen information more artfully tweaked in favor of a sponsor's drug.

You can access this article here, but you will first have to register at http://www.cmezone.com/. I believe this was originally published in CNS News (November 2006), and is now being emailed to various physicians as a free CME activity.

To get a feel for how very good the ghost-writer is, you have to know that the generally accepted first-line treatment for anxiety disorders is one of the antidepressants, either one of the SSRIs or the SNRIs. The sponsor of this article, Schwarz Pharma, unfortunately does not market one of these first-line treatments, being saddled instead with Niravam, which is alprazolam orally disintegrating tablet. It's a fancy version of that old standby, Xanax.

Our ghost-writer starts the article with the usual information about how common anxiety is, and how important it is for primary care doctors to seek it out. This lays the groundwork for the crucial treatment section.

The "Treatment of Anxiety Disorders" section opens with Table 4, above. What's the first medication you see? Alprazolam. So what? There's nothing tricky here, it's simply an alphabetical listing of medications. Well...it is unless you consider the two major classes of medications for anxiety to be "antidepressants" and "benzodiazepines." If they had used this classification, the first drug listed would have been clomipramine, followed by escitalopram, and so on. Alprazolam would have been lost in the middle of the chart somewhere.

But this is minor stuff; it gets more interesting. Under "pharmacotherapy," the first paragraph is a glowing tribute to the power of benzodiazepines. Sentence number one:

"Benzodiazepines have been used extensively for the treatment of anxiety disorders since the 1960s; newer benzodiazepine formulations, such as extended release tablets and orally disintegrating tablets, offer alternative dosing and delivery options."

Thus, our ghost mentions the sponsor's drug right away. Next on the agenda: address the concern that patients can become addicted to benzos. Our ghost quickly describes two studies showing that most patients don't get addicted. Whew! I was beginning to worry that I might have to start my anxious patients on SSRIs after all.

Later, ghost covers both buspirone and SSRIs/SNRIs tepidly.

Buspirone: "Buspirone has been demonstrated to have efficacy in the treatment of GAD, but not in other anxiety disorders or depression." Later we hear about a head-to-head between alprazolam and buspirone in which alprazolam worked more quickly and produced fewer side effects.

SSRIs and SNRIs: One mechanical statement of efficacy ("...most agents in this class now have FDA approval for several anxiety disorders") followed by two gory paragraphs about how awful SSRIs are when it comes to drug-drug interactions (Niravam doesn't share this liability, of course).

There are many more instances of the Power of the Tweak, but I'll let you discover the rest. I wouldn't want to deprive you of your own thrill of discovery!