Wednesday, August 26, 2009

A MECC that BLISSfully keeps Promotion in Medical Education

Recently, medical writers from across the country have been forwarding me blatant examples of how medical education companies are currupting the basic tenets of continuing medical education. Although I've become jaded, this particular company astonished even me with their willingness to do away with the pretense that industry-funded medical education is anything other than advertising.

The company is called Brand(x) and they are based in the United Kingdom. They are mainly an advertising firm but they have a robust medical education department. Here is a screen shot from their website in which they explain their conception of "medical education."

If you can't quite make out the small print, you can reach this page by going to the home page, clicking "enter" then "services" then "med ed." Here is the definition of CME, Brand(x)-style:

In today's business environment clients increasingly recognize that to get the best results, medical education must be led by a clear understanding of what the brand stands for and be closely integrated with the promotional strategy. At Brand(x), we are uniquely placed to provide the exceptional skills, which will help shape your educational strategy and implementation so that your brand's business objectives are met.

The company has developed its own process for making sure CME promotes a drug company's brand. It's called "BLISS," an acronym for "Brand Led Integrated Support Service." Here's a screenshot showing how they make CME more BLISSful:

Recently, Dr. Murray Kopelow assured the Senate Special Committee on Aging that his organization, the ACCME, has everything under control. In fact, here is what ACCME's standards for commercial support has to say about the content of CME:

The content or format of a CME activity or its
related materials must promote improvements
or quality in healthcare and not a specific
proprietary business interest of a commercial

But here is what Brand (x) has to say about CME:

BLISS ensures that your medical education programmes and strategies are synergistic with your brand's promotional strategy and execution.

I guess ACCME will need to hire a few more compliance officers.


Anonymous said...

OK. Now you are resorting to the old pharmaceutical marketing trick of leaving a trail of bread crumbs between fact statements and then drawing an unsupported conclusion.
1. This company is non-US and operates in an environment that does not have a similar system.
2. "Medical Education" is a broad term that especially in an agency context (such as this clearly is) encompasses on-label, company controlled "education" about products (in the US properly regulated as promotion).
3. You have provided no evidence that they are involved in organizing or influencing CME provided by an ACCME-accredited provider

With so much REAL scandal out there, you undermine your own credibility when you engage in such exercises. Stick to pointing out egregious cases like Emron in your previous piece.

This is just misleading.

Daniel Carlat said...

Anonymous--you make some good points. Let's see if we can resolve this. I just emailed the following to Brand (x):

"To the medical education division:

I am a U.S. physician and blogger critical of industry funding of continuing medical education. I recently found your website and posted an article about it here:

A commenter on the post believed that I was misleading in implying that your company is advocating the use of continuing medical education to promote company's products. By "medical education," are you referring to what in the U.S. we refer to as accredited continuing medical education, or are you referring to promotional programs?

Thanks very much in advance for your clarification.

Daniel Carlat, M.D."

I'll let you know if I get a response.

Doug Bremner said...

lmao. Another similar vein you haven't covered here yet is the private firms that offer to "manage key opinion leaders" like In other words for a fee they will help your company corrupt the academic medical system to increase your profits even if at the expense of patient health not to mention runaway healthcare costs. I think Howard Brody on his "hooked" blog put it well when he cited history of how medical "professors" used to charge fees for lectures which they pocketed. We are pretty much back to a system where medical professors use their positions to personal financial advantage.

bmartinmd said...

You're missing Anonymous's point and (surprisingly) some basic understanding of how CME works in the United States.

BrandX, as Anonymous wrote, is in the United Kingdom. The ACCME has purview only over US-based CME. A little homework would reveal that BrandX is not accredited by the ACCME to provide CME to US physicians. By the company's own description, it's offering promotional education, not certified CME (at least as it is understood in the United States).

Now it's possible that BrandX could be a cosponsor of US-based CME, in conjunction with an ACCME-accredited provider, but I find that prospect dubious--particularly in the current CME climate.

Daniel Carlat said...

But many MECCs are not accredited and yet contribute to accredited CME by "promotionalizing" medical information. In fact, this is probably a more common scenario than MECCs actually being accredited. I doubt that ACCME requires that contributing or co-sponsoring MECCs have to be located in the U.S. I am far less dubious about the possibility that Brand(x) has co-sponsored or otherwise contributed to U.S. CME than you are.

At any rate, the very best that can be said about Brand(x)is that it is indicative of a prevalent attitude toward medical education both in the US and the UK--namely, that it is appropriate to transform it into a form of drug advertisement. And I hope we can all agree that this does a disservice to doctors and patients.

Aubrey Blumsohn said...

Yes, given that this is a British company, and some basic understanding tells us that science, and education in the USA are superlative and filled with integrity and trustworthiness, this post could have been written a little more tightly.

The responses about "medical Education in an agency context" and the glories of "certified CME" otherwise remind me of a cluster of little hemorrhoids.

bmartin said...

Aiyiyi. Why do I bother?


If you can find an example of Brand(x) cosponsoring a certified US CME program, my hat's off to you.*

But I think it's highly unlikely that any US-based ACCME-accredited company/organization would work with the UK-based Brand(x) to produce certified CME for US physicians, especially in this day and age.

Brand(x) very blatently describes itself as a branding and advertising firm. The ACCME-accredited co/org just wouldn't risk the association, imo.

* And as you know, CME cosponsors must be publicly acknowledged in the CME program materials.

Daniel Carlat said...

To Anonymous who posted about the FDA and the Center for Professional Development--I did not publish your comment because it wasn't relevant to this posting.

Anonymous said...

As other posters, I don't get why you want to corrupt the argument by attacking the straw man of blatantly promotional activity by a non-US firm that is not in the business of accredited CME. And why do you refuse to single out the academic physicians who are the actual perpretrators of corrupt information? For that matter, aren't the worst recently reported cases in this regard to be found in academic institutions?

Sarah Glenn said...

Some MECCs in other countries do pair with ACCME-accredited entities to produce CME directed at American physicians. This company's approach definitely should raise some red flags.

Michael S. Altus, PhD, ELS said...

At meetings of organizations such as AMWA (American Medical Writers Association; and ISMPP (International Society for Medical Publication Professionals;, MECC leaders are out in front in leading discussions of issues of ethics in medical publishing.

One MECC, i3 Statprobe, went out in front publicly in its 1-hour webinar, “Medical Publications in the Crosshairs of Public Scrutiny”, August 27, 2008. Go to _ and register for free to view the webbinar. The slides are available separately at _

The final 10 minutes of the webinar were for questions and answers, during which I participated.

Michael S. Altus, PhD, ELS said...

To CME or not to CME: That is NOT the question.

The "purpose" of the Carlat Psychiatry Blog is to "test" the “hypothesis” that "allowing pharmaceutical companies to sponsor accredited medical education leads to many bad things...."

Dr. Carlat's post, "A MECC that BLISSfully keeps promotion in medical education", approaches the subject within the context of testing the "hypothesis" about the effect commercially supported CME. In reply, a number of comments deal with what CME is and isn't.

But the focus in this post and in some of the comments on the effect of commercial support on CME misses the important issue. It does not matter if the material is accredited CME or unaccredited ("promotional"). It does not matter if the MECC flies a Union Jack or a Stars and Stripes.

The only issue that really and truly matters is whether or not the information is accurate, reliable, objective, and (fill in your favorite[s] here).

Unknown said...

I am afraid this is a storm in a teacup.
Brand(x) is a promotional agency. In Europe we have "medical education" which is governed by various Promotional Codes of Practice. It is seen as education as supported by pharma, which the recipients know is a "promotional" activity (whether or not it is unbiased, independent, etc.) It is not CME accredited, nor is is purporting to be non-promotional by the kinds of standards as set by ACCME. However, as US observers you may be surprised by the high quality and unbiased nature of this style of activity.
Accredited educational programmes are also "CME" here and follow rules broadly in line with your own ACCME.
Brand(x) may possibly act as a co-sponsor with a US Provider (although there is no information presented showing that they have done so, nor do I have knowledge of this)--in my own opinion there are US CME Providers who would break ACCME rules and would find co-sponsors of this ilk for commercial gain--*this* would be worthy of your efforts to investigate.
Brand(x) is a well respected promotional agency in Europe, that does "medical education", and I suspect that they would have been utterly baffled by your email.
Keep up the good work, but it may be worth letting go of this this particular non-story;-)
Eugene Pozniak
MD, Siyemi Learning (a European CME Provider) and Programme Director of the European CME Forum.
And with no connection or relationship with Brand(x)

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