Monday, August 4, 2008

BusinessWeek Covers Medscape Corruption Story

This week's edition of BusinessWeek features an article entitled, "Teaching Doctors--or Selling to Them?" Written by Arlene Weintraub, the article focuses squarely on the commercially-funded CME racket, and its cornerstone example of bias is none other than Medscape's ridiculous CME article promoting Janssen's Invega (paliperidone) for the treatment of schizophrenia. This was the story I initially broke on this blog here and here.

Weintraub does a great job of explaining to a lay audience exactly how continuing medical education has become an auxiliary marketing arm of the pharmaceutical industry. After leading with Pfizer's decision to stop funding MECCs and Zimmer's (maker of orthopedics devices) new policy to stop funding any CME at all, Weintraub points out that:

These moves are a blow to the marketing firms but by no means the end of their lucrative, multifaceted role. There are hundreds of such firms in the U.S. that design ad campaigns, hire doctors to educate colleagues about devices and medications, and produce conferences. Over the past decade, CME has become one of their most profitable businesses, as manufacturers have increasingly paid for the courses. Industry support for CME has quadrupled since 1998, to $1.2 billion a year, according to the Accreditation Council for Continuing Medical Education (ACCME), an organization in Chicago that approves CME providers. More than half of that is funneled to marketers, with the rest going to hospitals, medical associations, and other nonprofit entities.

The article goes on to describe my experience with Medscape's blatantly promotional Invega course. Particularly precious is Johnson and Johnson's response to Weintraub's request for a comment:

A spokeswoman for J&J's Janssen unit says in an e-mail that the company has no influence over its CME providers' selection of course content or faculty. "The accredited provider is solely responsible," she says.

Talk about turfing the blame to someone else! I imagine that Medscape is none too happy with this quote. Meanwhile, Medscape comes across as fairly lame, because its CEO, Steven Zatz, defended the article by saying that they had recently "updated" it, but then refused to specify what changes were made. The answer, as far as I can see: none.

Finally, the story ends with what is becoming a fascinating case study of how one company, Vox Medica, is pretending to comply with ACCME's new policy forbidding marketing companies from producing CME. Vox Medica is a multi-national pharmaceutical advertising firm with headquarters in Philadelphia. Promotional CME has always been an integral part of its business. Last year, in response to ACCME's call for firewalls between marketing and education, they "separated" their CME unit, "The Institute for Continuing Healthcare Education" from the main company.

Is this separation real or simply a ruse to make ACCME happy? Decide for yourself. Here is Vox Medica's website. At the top of the page is their rather unfortunate slogan: "At Vox Medica, we are healthcare thinkers for hire." To the right of the slogan are links to their three major divisions. The top link is...that's right, The Institute for Continuing Healthcare Education. The message is clear to the pharmaceutical executives who log on to the website: Vox Medica is in charge of producing CME that will enhance product sales.

There's a bit more here. In the new corporate shell game of "My CME division is unrelated to my marketing division," physical addresses matter. Here is Vox Medica's contact information. They say they are located in the "Curtis Building," suite 250-S, but they do not mention their street address. Here is The Institute for Continuing Healthcare Education's contact information. They say they are located on 601 Walnut Street, Suite 275-W, but they do not mention the name of their building, which is, of course, the Curtis Building.

The entertainment becomes even more rich when you look at the comments section for this article. Stephen Lewis, who is quoted by Weintraub and who is referred to as "Vox Medica's medical education chief" takes great exception to her error:

Arlene, the BW reporter, got the facts wrong in this piece in two areas: first, "marketing firms" can not be accredited providers of continuing medical education. The editorial she writes here states that I am with Vox Medica, even though I have been employed by the Institute for Continuing Healthcare, an independent corporation accredited by ACCME. Second, and more important, she misses the fact that all organization types -- medical education companies, universities, hospitals, and professional societies -- are paid by pharma via education grants to conduct unbiased education. Disappointing.

Since Vox Medica owns your company, Weintraub assumed that your employer is Vox Medica. Thanks for clarifying, Stephen. We'll file this one under "False sanctimony."


Anonymous said...

"To the right of the slogan are links to their three major divisions." Just a comment on terminology: a "division" is part of a company. Later in your post, you say that Vox Medica owns the Institute for Continuing Healthcare. That implies to me that the Institute for Continuing Healthcare is a separate corporation (or other legal entity), not a division.

Does the distinction matter? It does for some purposes, but probably in the situation you're describing it probably makes little or no difference. I suspect that Vox Medica controls what happens in its subsidiary, directly or indirectly.

Question: you say Vox Medica is pretending to comply with ACCME's new rule. But are they pretending to comply or are they in fact complying? If the former, someone should report their noncompliance to ACCME. If the latter, the real problem may be that the rule doesn't really accomplish anything meaningful, even if fully complied with. The remedy for that would be to change the rule.

Sorry about the nitpicking, but I can't help myself. Occupational hazard.

Daniel Carlat said...

These are good points. ACCME's guidelines state that a CME provider cannot be owned or controlled by a commercial interest. From Vox Medica's website, it is impossible to know much about the nature of its relationship with the Institute for Continuing Healthcare Education. By posting a link to the CME company on its "about us" page, there's an implication of a close relationship, even one of control. I assume that their legal department has scrubbed through all their documents to be able to argue that they are in compliance with the letter of ACCME policies. But the spirit of the policy, ie., a meaningful firewall, is highly unlikely to exist.

Anonymous said...

Since these companies are not publicly held, we unfortunately can't look at their SEC filings to find out their corporate structure. Perhaps both Vox Medica and the Institute are owned by natural persons, probably the same ones or substantially the same ones. Can a CME company be under common control with a commercial entity?

Anonymous said...

An August 4, 2008 article, "Business Week -- Pfizer's Fallout", at Policy and Medicine blog ( states that the article "is basically a rehash of the Pfizer MECC decision along with some free PR for Danny Carat, MD, the gadfly anti MECC blogger (who by the way has no conflicts of interest except that his CME newsletter business will increase if he gets his way and ends commercial support of CME – oh, yeah, he forgot to mention that in the article – such a slip)."

Dr. Carlat, did you inform the Business Week reporter of your CME newsletter?

Daniel Carlat said...


Of course I informed the reporter of this conflict, as I do whenever I talk to a reporter. Furthermore, unlike Thomas Sullivan of Policy and Medicine, I broadcast the fact that I make money from CME right on the home page of my blog, in bolded font. You'll have to search a bit to find out that Mr. Sullivan is founder and owner of Rockpointe, a MECC that produces dozens of industry-supported symposia!