Tuesday, September 22, 2009

GlaxoSmithKline Will Fund MECCs Under the Table

Yesterday, I reported on GlaxoSmithKline's announcement that they would no longer fund commercial MECCs (Medical Education Communication Companies) to produce CME programs. The big question was whether the company would allow academic centers and medical societies to subcontract course production out to MECCs, an arrangement more genteelly known as "co-sponsorship."

I just received the answer directly from Mary Anne Rhyne, GSK's GlaxoSmithKline Corporate Communications Director. Rejoice, all ye MECCs, your loophole is intact!

In this earlier op-ed piece in the New York Times, I had referred to industry-funded CME as a money laundering operation, in which drug companies do not directly pay doctors to give lectures, but instead pay a MECC to hire and pay the doctors. This provides the illusion that the drug company is not involved in the program, when of course the program wouldn't happen without company funding.

With this new brand of CME "reform," both Pfizer and GSK are simply adding another layer to this laundering operation. Now the money will go from the drug company to the academic medical center to the MECC to the doctor.

Over the years, MECCs have become experts at creating a series of dog and pony shows called CME. They have the process down to a science. They know how to make the flashiest slides, hire and manage the best key opinion leaders, rent out the nicest conference rooms, and serve the tastiest food. They make the process so seamless and effortless that academic medical centers are only too happy to hire them to do the dirty work of actually putting on the courses. Under GSK's new policy, I predict that universities will get the big grants and will pass on a chunk to the MECCs, keeping a healthy slice for their own highly profitable CME departments.

Unfortunately, the actual medical education will continue to be slanted in favor of the most expensive drugs and medical devices.

By the way, I also asked for a list of the 20 favored academic centers. The GSK spokeswoman said that this will be posted soon on www.partnersinknowledge.com, their website for grant applicants.


Anonymous said...

I see a bit of Public Relations in the works here from GSK with these "transparency" actions. Maybe GSK will be taking a major fall soon so they need to boost their credibility and "honesty" before they get the ax? Some will buy into these transparency actions, but thanks for the few who see right through that and expose it!!!! For some REAL transparency, why not publish all MECC/CME funding from the 1990's on and the doctors associated with them? Now THAT is a list to see that can shed some light on the reality of how insidious these CMEs are! The posting of these lists by pharma to reflect current funding is simply public relations not transparency. Some of us know the difference. Great article!

SteveM said...

Pointing to sources of funding is near meaningless. Because that information has already desensitized the consumer of CME content. I.e., financial ties are itemized with the bios of CME presenters. I'm sure the audience notes the associations and yawns.

What's required for effective policing of CME content is actual policing of CME content. In other words, if a GSK wires a biased message into a CME course, an oversight authority notes not just the funding source but the specific factual points of bias in the content, both inclusionary and exclusionary.

But post-release content review would require doctors to call a spade a spade. I.e., link the offending physician to tarted up content which would be a professional/ethical thumb in his/her eye.

I dunno, excepting Danny and a few others who do it informally, does anyone have the temerity to take that review process on as a formal exercise? I.e., set up a web page of active CME courses and critiques of bias.

And why is pre-emptive content review for bias not done anyway in a neutral editing process before the CME content even goes out? That would solve the problem and save the pimps...er...hired guns from embarassment.

Daniel Carlat said...

Steve--Your point is well taken. Unfortunately, vetting the content of commercial CME is incredibly time-consuming and is very difficult for anyone other than a physician with a specialty in a specific content area. Needless to say, getting the funding to pay an army of CME-vetters is going to be tough.

SteveM said...


I appreciate the response. Points well taken. I'm a process improvement guy so focus on what's objectively broken and how to fix it. So apparently:

The funding linkages, even embedded in the presentations do not dissuade presenters from using biased content. Which means banging that drum is effectual. So don't count on it being a primary motivator for positive change.

OK, so then if the fundamental objective is to minimize CME bias and funding identification does not work, how can that be effected?

The obvious meta-task is simple brainstorming ways to fix the problem by stakeholders in the business. Is anybody actually doing that? Has anybody suggested it?

For example have the APA stand up a certification process for psycho-pharmaceuticals and have the drug company pay for content certification. I.e., No certification, no CME credits.

Or have Psychiatric Times or another vehicle set up a blog for CME critiques. That would be pretty simple to maintain.

I acknowledge my ignorance of the CME process, but it is a process and if there is a shared understanding that content bias is real and undesired, then professional standards would suggest that members would be clamoring for that process error to be corrected.

If there is not that shared understanding then psychiatry has some deeper philosophical and ethical issues to deal with beyond CME. The overarching professional Weltanschauung thing.

Frankly, the indifference to obvious and reparable process flaws I see as a layman is both striking and disheartening. If I were a doctor, I'd be pretty p.o'd.

P.S. Check with DocRighteous - Can I say "p.o'd" within impinging on anyone's sensibilities?

InteractMD.com said...

Another great post. I took the "bait" thinking GSK was out of the MECC business, but you have opened my eyes again.

I linked you on my website, InteractMD.com, at http://interactmd.com/new/index.htm
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Dr. Mike