Tuesday, January 22, 2008

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.


Anonymous said...

Keep it up, Dr Carlat. You are right; people who preach the current gospel are the heretics in our field.

As I grow older, and hopefully wiser, the real addiction that endangers our society is money, not substances. Observe its power with our colleagues.

Anonymous said...

I couldn't help but notice that Dr. Samuels "decried most other MECCs, calling for the abolition of industry- sponsored satellite symposia at major medical meetings."

I believe that Pri-Med -- for which he directs the neurology CME -- has become one of the most successful independent medical meetings companies in numerous therapeutic areas.

As logic would have it, if one does away with satellite symposia at OTHER "major medical meetings," that leaves more $$ for sponsored CME programs at Pri-Med-hosted meetings.

By the way, from what I have seen, Pri-Med does a very credible job. But it's hard to deny that what we have here is another example of a single company that, 1. hosts the meeting, 2. works with industry-sponsors on presentation materials, and 3. accredits the CME. And you can't lay the blame solely at the feet of the pharmaceutical industry for these patent conflicts. They have no other choice but to go along with this. (In fact, if anyone out there wants to market a neurology drug, it sounds like Dr. Samuels is an important guy to get to know.)


I hope that the "conflict of interest" accusation hoisted upon Ms. Bastow of UpToDate (a company I had not heard of before), does not negatively influence the Macy Foundation recommendations. They may very well be the best opportunity at hand to help temper the groundswell of opinion that implies that medicine is for sale.

James M. La Rossa Jr.
Publisher & Editorial Director
MedWorks Media Global
Los Angeles, CA

Anonymous said...

By the way, I coincidentally received a Pri-Med West invitation for its Conference & Exhibition at UCLA. Featured prominently on the invitation (link below) is the Harvard Med. School logo. http://view.ed4.net/v/2OJPSF/TBXPS/