Wednesday, March 5, 2008

JAMA and British Medical Journal Weigh in on CME

Recent issues of two of the world's major medical journals carry articles critical of industry-funded CME, both of which are required reading for those following this form of legalized corruption.

In the current issue of JAMA (Journal of the American Medical Association), Dr. Robert Steinbrook of Dartmouth Medical School provides this comprehensive overview of CME financing. After reviewing several options, he concludes that the best solution is to completely end industry support of CME:

"Although eliminating support from pharmaceutical and medical device companies would involve more change than the alternatives, this approach will likely allow the medical profession to control its own continuing education. The current situation is at best very troubling."

See also Merrill Goozner's excellent coverage of this issue in GoozNews.

For a bit more spice, read this article in the February 23 issue of the British Medical Journal.

Entitled "Doctors’education: the invisible influence of drug company sponsorship," the article is based on documents leaked from one of Australia’s largest medical education companies, Healthed. While the company’s brochure states that "all content is independent of industry influence," in fact internal emails document that sponsors frequently suggest speakers for particular courses.

Three companies were implicated in these emails: Sanofi-Aventis, CSL (marketer of the headache medication Tramadol), and Organon. All three companies successfully recommended speakers, apparently at the instigation of Healthed each time.

The most egregious smoking gun involved CSL, which sent an email to HealthEd in reference to a headache course, saying that they would like HealthEd to "determine the speaker’s opinion re: Tramal as I would like to ensure he positions it appropriately." HealthEd replied that it "will reconfirm opinion of headache speaker re: Tramal to ensure balanced presentation."

The language of obfuscation is eery here. You have a strong sense that the emailers know they are doing something wrong and are tweaking the language to avoid getting caught red-handed. In MECC double-speak, "balanced presentation" means "in line with marketing aims," and "positions appropriately" means "will push the sponsor’s drug."

Another interesting tidbit from this article is that Healthed offers sponsors who pay the most money ("platinum sponsors") special privileges. According to an extract from an email sent to Schering Plough from Healthed, this privilege includes the chance to "work with us to determine a speaker and topic for the programme."

The most flinch-worthy part of the article was the furious back-pedaling by Heathed’s director, Ramesh Manocha. When asked why sponsors were allowed to suggest speakers, he said that these suggestions were "filtered" through the company’s working group. But then he said these leaked emails were from 2006, and that Healthed has really "tightened up" since then. Unfortunately for Manocha, he was then confronted with one of Healthed’s 2008 brochures which states that "at each seminar as a platinum sponsor your company can . . . work with us to determine a topic that is on message for your product area." Manocha had to do another Australian two-step: he said the brochure was no longer used and that the wording should have been changed. By the way, platinum sponsors pay about $9000 per one-day seminar to obtain their extra influence.


Anonymous said...

Perhaps even better than Ray Moynihan's BMJ article is a contemporaneous radio program he produced on just the same topic, with interviews with the chief protagonists and others. Transcript and audio are here.

Supremacy Claus said...

When pharmaceutical companies put their funding through the medical school administration, all problems go away. How is that explained?

Anonymous said...

The MED ED Prayer:

Our Pharma, who art in heaven,
Hallowed be thy Brand.
Thy kingdom come,
Thy marketing be done,
In education as it is in promotion.

Grant us this day, our daily Med Ed.
And forgive us our lapses in bias,
As we forgive the CME provider in the name of balance.
And lead our faculty, not to objectivity,
But to deliver the “appropriate” message.

For thine marketing message,
Is the power, and glory,
For ever and ever.