Wednesday, September 24, 2008

Eli Lilly: Ethical Confusion Continues

Eli Lilly just became the first drug maker to announce that it will voluntarily disclose payments to physicians of $500 or greater. (See this coverage in Pharmalot.)

This is the latest in a series of Eli Lilly firsts in transparency. They were the first company to disclose their educational grants, and the first to endorse the Physicians Payments Sunshine Act. This is all good stuff.

So why do I say Eli Lilly is "ethically confused"? Because they still shamelessly participate in marketing deception. They
hid risks of Zyprexa from doctors long after they knew about them, and still deny that this was wrong. They continue to fund a malpractice insurance company, PRMS, to provide sham risk management education to psychiatrists in an effort to prevent them from switching patients to less toxic antipsychotics. In this particularly ugly marketing tactic, they are paying attorneys to do their "education," payments which would remain hidden even under their new disclosure policy.

So, to borrow a phrase from Merrill Goozner's Integrity in Science Project, Lilly deserves both cheers and jeers for their efforts to reform themselves.


James M. La Rossa Jr. said...

Recent reports on The Carlat Psychiatry Blog and the NY Times that Pfizer would no longer directly fund medical education and communication companies, and that both Lilly and Merck would disclose speaking fees it pays to doctors, show that industry is responding responsibly. This is in direct contrast to those that should be leading this debate to begin with. It was recently reported, here, that the ACCME commissioned and funded a bogus literature review to determine whether or not commercial support biases CME (Cervero and He), which concluded that "to date there is no empirical evidence to support or refute the hypothesis that CME activities are biased."

As I've written in the past, industry is not to blame for the present CME crisis -- they are doing what industry does -- marketing their products. The blame lies with the ACCME and the medical associations who have used industry as profit centers for its own enrichment. The FDA has played an unwitting part in the crisis by associating CME-accreditation with unbiased programing, mandating, in effect, the creation of a billion dollar CME industrial complex, which has compromised the standing and reputations of physicians.

I respectfully submit that the only way out of this morass is to give the power back to physicians. Physician-education does not need "regulating." It is an insult that doctors are caught in this regulatory morass. If CME is based on the honor system and not mandatory, doctors can use their own judgment as to what CME events they go to -- whether that be pharma-sponsored or university-hosted events. Why not let "Free Market Principles" dictate who keeps up with the literature and who does not. I believe that physicians will always want to gather with colleagues at meetings, grand rounds and the like, where new medical information will be discussed. Doctors who don't keep up will be challenged by patients, who (like it or not) are becoming highly educated themselves. And God-forbid you are ever sued, the first thing the opposing lawyer will ask you on the stand is about your level of ongoing education. So, it is in everyone's best interest— legally, socially, and financially—to keep up with the literature. If society can't hold physicians (who've spent seven years of higher learning as is) to the honor system regarding their continuing medical education without worrying about a dimming of medical services, than we have more problems that the APA, the WPA, or the AMA can handle. Note there is no mention of the ACCME in the last sentence. They should be abolished, as the Cervero and He ACCME-commissioned paper proves.

In summary, it should be clear to everyone that the CME problems written about so passionately on this blog will never be solved until Washington and its hypocritical regulations are flushed from the system.

Daniel Carlat said...


Thanks for your great comments. A couple of responses.

First, there's plenty of blame to go around. Industry is a profit making endeavor and they market, eat, and breathe, in that order. But they have choices in how they choose to market their products. It is time for them to realize that they are as complicit as physicians and MECCs in propagating sham CME, and they should put their money elsewhere, as Pfizer is starting to do.

Should we abolish accredited CME? If it adds no value to physicians' education, then yes. If specialty societies can take over lifelong education efficiently, yes. But these are still open questions. The idea that physicians who neglect their education will be forced out the profession as a result of malpractice doesn't give me a heck of a lot of confidence when I become a patient. I don't want to be the botched case that exposes a given doctor's lack of proper CME!

James M. La Rossa Jr. said...

Dear DC: The question for me is not whether accredited CME has value or not, or whether it would be appropriate for medical societies to pick up the slack should the practice be abolished, but that -- like lawyers -- doctors do NOT need regulated, mandatory, CE, to be good professionals -- and that left to their own devices, they will continue to read journals, attend meetings, etc. for a variety of reasons of which the threat of malpractice is just one. The "market forces" that make up a thriving medical practice are the same as those of a thriving legal practice; cream will always rise to the top as the saying goes. My fervent belief is that if you abolish this onerous system of mandating CE, that grand rounds, medical meetings, and yes, industry-sponsored events will continue to thrive. The difference is that if doctors can pick and choose for themselves -- without the issue of who will pay for the credits -- they are more than capable of judging which CME program has value and which is biased, which forces all parties involved to put on the best, most objective programming, lest the seats remain empty. As it stands, the CME industry is broken and nobody stands to win regardless of the type of reform. I don't believe that patients will suffer should regulated CME be abolished. Do you? And if so, why?