American Psychiatric News: Guess the CME Sponsor!

Last July, I blogged on a CME conference at the New York Marriott called the “Third Annual American Conference on Psychiatric Disorders.”

The bottom line was that McMahon Publishing was using the conference to make boatloads of money from pharmaceutical companies, charging them $85,000 for each 90 minute symposium, and offering to write up articles based on each symposium for a mere $103,000 each. Well, the conference took place in September, and now, 4 months later, the first of the $103,000 articles have been published.

Shall we have some fun?

Yes, it’s time to play that always entertaining game of commercial CME corruption, "Guess the CME Sponsor!"

We’ll focus on the article entitled “Differential Diagnosis and Management of Bipolar Disorder.” It is published in a "Special Edition" of American Psychiatry News, December 2008, Vol 1, No. 12. I haven't found this article online yet, but here is the journal's website.

First, who wrote the article? We have no idea. Although the “faculty” are listed as Glenn J. Treisman, MD, PhD, and Jennifer L. Payne, MD, the article was presumably ghostwritten by a medical writer hired by American Psychiatry News.

And what about disclosures? There’s already a problem here. Under “faculty disclosure”, Dr. Treisman reports “no financial interests to disclose.” Must be a typo. Because at this December 2008 Pri-Med conference, Dr. Treisman reported being a speaker for both Boehringer Ingelheim and Abbott, and in this May 2007 CME program, he said he was on Pfizer's speakers bureau as well. In the past, Dr. Treisman apparently spoke for so many companies that he simply disclosed that he was on the “Speakers Bureau for most pharmaceutical companies” according to this Drexel University CME program.

Let’s move onto the article itself. But remember the rules: no peeking at which drug company sponsored the article until we’re done!

The article is built around these two case studies:

1) Chelsea, a 20-year-old college student, uses alcohol and marijuana and presents to a doctor with symptoms of mania. Her psychiatrist diagnoses her with bipolar disorder and comorbid substance abuse, and starts her on valproate. Over the next 1 ½ years, however, Chelsea does quite poorly on valproate, and has four manic episodes with psychotic features. Eventually, she is admitted to the hospital, and Zyprexa (olanzapine) is added to valproate. Four weeks later, Chelsea has improved: her sleep is better and her mood is stable.

2) Greta is a 40 year old married school teacher who presents with symptoms of depression. Her psychiatrist prescribes fluoxetine, but 5 weeks later she has racing thoughts, poor sleep, and her diagnosis is revised to bipolar disorder II. At this point, her psychiatrist switches her from fluoxetine to Symbyax (Zyprexa-fluoxetine combination capsule) and lithium. Three weeks later, according to the article, “Greta has improved. She is sleeping better, is less irritable, is finding it easier to focus at work, and has begun marriage counseling with her husband. Generally, she is statisfied with her treatment.”

Now let’s do our analysis. In the world of bipolar treatment, the major branded players are: Abilify, Geodon, Seroquel, and Zyprexa. Risperdal, valproate, lithium, tegretol, and lamotrigine are also used, but they are all off-patent, and therefore drug companies would be unlikely to support education featuring them.

Would Bristol-Myers Squibb support this program? Doubtful, because Abilify is not mentioned in either case, though it is mentioned in passing as a treatment option in some of the smaller-print commentary. Pfizer or AstraZeneca? Certainly not, because neither Geodon nor Seroquel appear to have entered the treating psychiatrists’ minds.

Eli Lilly? Hmmm. Chelsea finally got better after she was started on Lilly’s Zyprexa. Greta got better on Lilly’s Symbyax. I think we have a real candidate here.

Let’s flip to page 25 of the journal: “Supported by an educational grant from Eli Lilly and Company.”

We have a winner! Those of you in the audience who correctly Guessed the CME Sponsor will receive a $100 gift certificate to McDonalds, which you will tear through during your first day on Zyprexa en route to an average weight gain of one pound per week—but of course we heard nothing about either Chelsea or Greta gaining any weight. Contrast this with Current Psychiatry’s AstraZeneca’s CME advertisement for Seroquel, in which Dr. Goldberg’s patient, Mr. S, gained 18 pounds in one month of Zyprexa treatment.

As usual, nothing inaccurate was said in this article, and I'm sure Symbyax is a perfectly delightful medication for someone out there, although I would never prescribe it because I hate turning patients into blimps. But this article is an advertisement, and should not have qualified as accredited medical education. Shame on Dr. Treisman, the journal's editor, and McMahon Publishing.

In Industry CME, $85,000 buys you 90 minutes, $103,000 buys one article

I recently received an e-mail inviting me to register for a big psychiatry conference in New York City. Called the “Third Annual American Conference on Psychiatric Disorders,” it is presented by Johns Hopkins Medical School, but is—get this—“developed through a strategic educational collaboration with the Institute of Applied Science & Medicine.” IASM is part of an umbrella MECC called McMahon Publishing Group, purveyor of innumerable throwaway journals like American Psychiatry News, CNS Senior Care, and Lord knows what else.

Once on the conference's website, I clicked on their “Educational Prospectus,” which provides a fascinating insight into the titanic scale of financial incentives that keep industry-funded CME so biased. This document is not meant for physicians, but rather for MECCs and drug companies who want to promote their products to impressionable psychiatrists attending the meeting.

Let’s look at this together, shall we? Call it a “guided tour of greed.”

First, go to page 2: “Educational Program.” Here, you’ll find information on the coyly named “Independently Supported Symposia”—which in less Orwellian circles is known as “Industry-Funded Symposia.”

IASM’s fee for a single, 90 minute ISS “slot” is $85,000. While this may seem excessive ($944/minute), your cost includes:

--“Exclusive support of a symposium slot” (Meaning no competition from any other drug companies trying to sell their products.)

--“Audience recruitment and session promotion” (Special placards and signage throughout the hotel designed to encourage psychiatrists to show up.)

--“Certification through Johns Hopkins University School of Medicine” (I’d love to know how much Johns Hopkins is charging IASM for this particular sell-out. I would guess somewhere in the high five figures.)

--“Registration report/summary of participant evaluations” (Ie., the names and addresses of a boatload of physicians for future promotional CME mailings.)

Now, let’s go to page 3: “Enduring Materials.” And I quote: “Based on the content presented at the live ISS, enduring material activities will be developed by the Medical Education and Communication Company (MECC) and distributed by the Institute’s educational partner, American Psychiatry News.”

For $103,000, IASM will prepare a “Special Report,” an 8-page, journal-sized monograph of approximately 4500 words with a 10-question multiple-choice post-test.

A bit steep for a measly review article, you say? But wait, there’s more!

-- "Certification of the Special Report monograph through The Johns Hopkins University School of Medicine" (I wish I could buy stock in this "Johns Hopkins" company--oh wait, it's a non-profit "university"--I forgot.)

--“Distributed in an issue of American Psychiatry News” (This is a mini-version of the supplements made infamous by Journal of Clinical Psychiatry.)

--“Online version of the Special Report monograph hosted on CMEZone.com for 1 year from the date of release” (Yes, CME Zone, once featured on this very blog for having created a sham CME article promoting orally disintegrating alprazolam (Shwarz’ Niravan) for anxiety disorders, arguing that it is safer than SSRIs.)

--“Distribution of the Special Report monograph from American Psychiatry News exhibit booths at national conferences for 1 year from the date of release” (After all, advertising is all about repeating the message over and over again—“the more you say, the more they pay.”)

--“Inclusion in an e-mail broadcast, Zmail, announcing online availability of the enduring material” (Even more advertising? Bring it on!)

There are several other pages detailing the separate responsibilities of various “partners” (in crime?), and a crucial bullet point clarifying that your fees do not include honoraria for faculty hired guns, or for their travel, lodging, and meal expenses.

Finally, notice that since this money-making scheme is formally sponsored by Johns Hopkins, Pfizer will agree to fund it if asked—clear evidence that their recent announcement that they will not directly fund MECCs should have little impact on the bias inherent in industry-funded CME.