Tuesday, November 13, 2007

How Money Doth Breed CME Niches!

First, my apologies for the sparsity of posts lately--I ran behind on some newsletter work and I have to keep my subscribers happy.

I just received a flyer from an outfit called "CME Peer Review" (look them up on the web here), a new company which has wormed its way into a brand new niche in the commercial CME world--"independent content validation."

This is NOT their marketing copy, but it might as well be:

THE PROBLEM: OK, you're making money hand over fist by providing drug company-sponsored "medical education" (nudge-nudge, wink-wink). It's a sweet gig, getting million-dollar grants to hire medical writers to scribble out pseudo-newsletters. Donald-me-no-Trumps, these are FAT profit margins...and all yours! So what's the problem? A new "regulatory environment," that's what. Suddenly, everyone from the New England Journal of Medicine to the Senate Finance Committee is whining about "conflict of interest" and "commercial bias." Haven't they read Nietzche?! You are beyond such fairy tales as truth and morality, but in order to maintain your uber status, you must play the game.

THE SOLUTION: At CME Peer-and Jeer Review, our "turn-key system helps you ensure your CE activities are valid, aligned with the public interest and compliant with regulatory guidance and accreditation standards" (that's lifted verbatim from their actual marketing copy!). Got an article sponsored by Pfizer pushing more docs to prescribe Geodon? Choose from our "ever-expanding independent network of reviewers" to find just the shill to give your article the seal of approval. Don't worry, we have a patented system of laundering our reviewers--they're spic and spam and ready to deploy our CME SCRUB DOWN (TM) process for your CME activity.


"We encountered a difficult situation in which management had already spent the sponsor's grant on a $100,000 rehab of his office shower. Then, at the last minute, we found out the activity was hopelessly biased. We called CME Peer-and-Jeer Review and our problems were solved--what a quick turn-around! Thanks, guys!"

"Your team found an issue in one of our activities--it was subtly promoting a competitor's drug! By helping to bring the activity back in line with the sponsor's agenda, you helped us secure double our original grant for next year. We feel so much more confident about our income stream, thanks to you."

CME Peer-and-Jeer Review: Your CME SCRUB DOWN specialists!

1 comment:

Anonymous said...

Darn. Just last night I said to myself that I better take a break and stay off the Carlat blog because I am becoming a "comment hog." (Is there an official noun for such a person?) And—WHAAAM—you hit me with this ... a two-by-four right between the eyes. I remember writing a few months ago that CME-accrediting companies were "coming out of the wood work." And if I can judge by today’s story—they’re still coming.

Imagine the irony that the litany of CME has become: The MedEd company puts on the "educational" program (using as many big name physicians they can muster) for the pharmaceutical client—going from meeting-to-meeting, lecture hall to lecture hall—one grand rounds to another. The sponsor gets its message out and the docs get free CME. But hold on. Don't we need another MedEd company to "peer review" the program just to make sure that the first MedEd company has not overly prejudiced its client’s message? And who are those "independent peer reviewers?" Wanna bet they are the same big name psychiatrists that were hired by the first MedEd company to do the presentations? Isn't this what drug dealers refer to as "stepping on" the product? The drugs start at the source, and at each distribution point, a little more junk is thrown into the mix and everyone down the line makes money. What you have at the end of the line after everyone takes their share, of course, is “pure” junk. And while this is pure literary license—these companies and the CME they generate have no literal comparison to illicit drugs, or "junk,"—the irony is very apparent, no?!

Who's to blame for all this craziness? Is it a) the first MedEd company? b) the 2nd "peer review" MedEd company? c) the pharmaceutical company? d) the speakers hired by the original MedEd company who should have "peer reviewed" the course as a matter of course? How about, e) the ACCME? Or, perhaps, we should blame f) the FDA for being such regulatory pains in the asses? Why blame anyone? Aren't A-F just doing the jobs they were hired for? That's what pharma does, kids, THEY SELL PILLS. What are they to blame for? In fact, arguendo, one can claim that the pharmaceutical industry is directly responsible for saving doctors a good deal of money.

In 1997, the APA charged psychiatrists about $125.00 per Cat. 1 credit to attend the APA workshops at the yearly convocation. At that time, the best CME-accredited journals charged about $30.00 per credit. Today, pharma picks up the CME tab, which has come in really handy since the insurance industry is doing everything in its power to drive MD's broke. So, there's the rub. When you paid for your own CME, it was independent. Now, that it's free...well...let's just say that compromises are being made.

(For the record, I was as much to blame for this as anyone. No one was more hell-bent on driving down CME costs in the 90’s than I was. In all honesty, journal publisher's never made a lot of money on CME in those days—it was always a value-added service to readers. Remember—that was the same time period in which the Clinton's introduced the "gatekeeper" concept to American medicine, which made it even more important to help our readers cut costs.)

Take the profit out of CME and a lot of question marks go away. But that won't fly until physicians take a stand. Hypothetically, if I could provide everyone reading these words with Category 1 CME credits—no questions asked—would you stop going to all of the dinners? Would you throw away all of the CME junk that came in the mail without so much as glancing at it? There's a reason why all of this CME craziness has arrived at your doorstep.

By the way—and I ask this admitting to my ignorance and with all due respect—when was the last time a psychiatrist was stripped of his/her license because they didn't have enough CME credits? I can’t even fathom that. As my Dad, a trial lawyer, used to say, “I’ll take that case, send my driver into court, tell him what to say, and win 10 out of 10-times.” They don’t make guys like my Old Man any more.

ps: I’ll leave this subject to the experts from here. I’ve said much too much about this already. (...and I’m trying to finish writing a book, publish a couple of journals, and adjust to Los Angeles as a third-generation NY'er—so I’m pooping out.) I will continue to read w/ great expectation, so I hope and pray that the Carlotblog continues to crackle. Cheers.