Top Harvard Neurologist: Macy Report is a "Stack of Cards"

Shortly after the Macy Foundation's report was released, I found myself in the Minot Room of Harvard Medical School's Countway Library, listening to one of the world's top neurologists trashing that report.

It wasn't exactly what I was expecting.

I was attending a medical ethics seminar hosted by Marcia Angell, author of the groundbreaking book The Truth About Drug Companies. In attendance were some of the harshest critics of excessive industry influence in medicine, including:
--Arnold Relman, former NEJM editor-in-chief and author of A Second Opinion: Rescuing America's Health Care
--Jerry Avorn, author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs
--Eric Campbell, the Mass General health policy guru who first-authored the recent NEJM study detailing the pervasive relationships between academic medicine and industry
--Jerome Greene, the physician and historian who wrote Prescribing by the Numbers: Drugs and the Definition of Disease
--A bunch of other wicked eminent people whom I didn't recognize

So you really have to hand it to Martin Samuels, the Neurologist-in-Chief at Brigham and Women's Hospital, for having the guts to defend industry sponsorship of CME. Although, in reality, Samuels was really defending only one particular MECC, Pri-med, for whom he directs the neurology CME course. He decried most other MECCs, calling for the abolition of industry-sponsored satellite symposia at major medical meetings.

At any rate, his most interesting comments related to the Macy Foundation report. Ironically, Samuels had been recruited to Pri-med by none other than Suzanne Fletcher, who chaired the Macy conference. And according to Samuels, one of the members of the conference's organizing committee was Denise Basow, a top executive of UpToDate. UpToDate is a multi-million dollar medical education company, but one that is not funded by industry. Instead, like my own Carlat Psychiatry Report, it is funded by subscribers.

So what? Samuels feels that the Macy Report's conclusions are neatly in line with the business goals of UpToDate--more emphasis on online practiced-based learning, and no further commercial sponsorship of medical education.

"This is an overt conflict of interest, and it should have been declared," said Samuels. "I find this report to be self-righteous and self-serving. It is so hypocritical that it will fall like a stack of cards."

In fact, Basow's affiliation was printed in the report, but I do agree that her involvement constituted a conflict of interest that should have been highlighted. But this doesn't besmirch the essence of the report--namely, that continuing medical education in the U.S. is critically ill, and needs emergency treatment.

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.