Pentagon Borrows Techniques of Commercial CME

While this blog generally focuses on how physicians sometimes manipulate information in response to financial incentives, last Sunday's New York Times covered another category of corrupted information brokers: military analysts hired to interpret the news. In a devastating expose, David Barsow details the ways in which the Pentagon has groomed former military men to deploy the official White House message to national TV audiences.

Any reader of this blog will immediately recognize the same techniques used by hired gun M.D.'s—the highlighting of the positive while downplaying the negative, the hidden conflicts of interests, the rationalizations, and, ultimately, the damage done to our nation’s sense of morality.

Television networks have long hired retired generals and colonels to serve as “independent” military analysts, brought on to help the public understand the meaning of the latest developments in war. Yes, they were once part of the military establishiment, but we assume that in their retirement they no longer have to answer to anyone, and they can provide a clear-eyed interpretation of confusing war-time events. At least, that’s the theory.

The truth is very different. “Hidden behind that appearance of objectivity,” says the Times, “is a Pentagon information apparatus that has used those analysts in a campaign to generate favorable news coverage of the administration's wartime performance….”

As a result of a lawsuit, the Times forced the Defense Department to release 8000 pages of e-mails and meeting transcripts detailing how these analysts are paid to say nice things about the army. According to newspaper, “internal Pentagon documents repeatedly refer to the military analysts as ‘message force multipiers” or ‘surrogates’ who could be counted on to deliver administration ‘themes and messages’ to millions of Americans ‘in the form of their own opinions.’”

The parallels to the industry-sponsored CME industry are eery. In both cases, “key opinion leaders” are paid to deliver the company message (the Pentagon uses the term “key influentials”); old boy networks ensure that friends reward friends; and e-mail trails of damning communications eventually expose the sham.

Unfortunately, military analysts and industry-sponsored CME are not the only examples of our country’s burgeoning culture of deceptive information-brokers. In the last couple of years, we’ve read about college loan officers referring students to banks in return for kickbacks (1) ; financial analysts entrusting their customers’ money to certain stock brokers in return for golf and gambling vacations (2) ; and government officials accepting lavish gifts from lobbyists for decisions that enrich their clients (3).

The moral? As information becomes more complex and specialized, it becomes more valuable to stakeholders. And where there is value, there is the opportunity for corruption, whether in medicine, the military, or any other field.

Author Calls his own CNS Spectrums Article “Ridiculous, Inaccurate, Simplistic”

C. Lindsay DeVane, a Professor of Psychiatry and an author of an ACCME-accredited article published in the journal CNS Spectrums has termed his article a “piece of commercial crap,” and said he had not read the final version before it was published, according to an e-mail he sent to this writer (read his e-mail here).

DeVane, who is Professor of Psychiatry and Behavioral Sciences and Vice Chair for Research at the Medical University of South Carolina, is one of three authors listed for an “Expert Roundtable Supplement” published with the May 2007 issue of CNS Spectrums. The supplement was accredited and produced by i3 CME, a medical education company owned by Ingenix, and was funded by Bristol-Myers Squibb.

Responding in an e-mail to questions I had about the accuracy of the article (read this e-mail here), Dr. DeVane said that he had originally been approached by Dr. Charles Nemeroff to participate in a videotaped discussion to be held at a psychiatric meeting in Hawaii. The discussion was to be funded by Bristol-Myers Squibb, which recently released the antidepressant patch, EMSAM. DeVane initially declined Dr. Nemeroff’s invitation, saying that he did not want to participate in a “circus debate for the sake of selling CME time.” However, he eventually changed his mind and participated in a discussion of antidepressant drug-drug interactions with Nemeroff and Sheldon Preskorn, another high-profile academician who often consults and speaks for drug companies.

After the broadcast, the CME company, i3 CME, presented DeVane with an article based on the discussion, apparently ghost-written by a medical writer hired by the company. DeVane called this a “ridicuous text… parts of it were inaccurate, simplistic, and [contained] over-generalizations.” It is not clear whether DeVane insisted that editorial changes be made. He had not read the final version, and advised that the article be ignored “for purposes of interpreting my research and views.”

The controversy involves a seemingly arcane topic in psychopharmacology, the issue of how drugs interact with other drugs in the bloodstream. In an earlier article in a different journal, published without pharmaceutical funding, Dr. DeVane had argued that these drug-drug interactions were rarely significant when prescribing antidepressants. According to DeVane’s e-mail, that article “represents my summary of the field and opinions.”

The CNS Spectrums article, however, claims that these interactions are often significant when certain antidepressants are used. The article also points out that EMSAM, the drug made by the article’s sponsor, has the advantage of not sharing these drug interaction liabilities. If DeVane’s earlier statements had been used as the basis for the article, then EMSAM could not have been claimed to have this competitive advantage.

In response to inquiries about the discrepancies in DeVane’s earlier article and the newer article, CNS Spectrums and i3 CME did not comment on specifics, but denied any irregularities regarding the planning or writing of the article. According to their written statement, “the faculty [referring to Nemeroff, Preskorn, and DeVane] remains comfortable with the positions they have taken in this CME activity….”

File article under: Corruption in High Places