Apres le Deluge: The CEJA Spin Cycle Begins

When the AMA adopted the 5^th version of the CEJA report on industry-funded CME, it seemed clear that this was an ominous and very bad sign for the future of industry-funded CME. I already posted my take on the report here (short version: say goodbye to most industry CME). Now we are beginning to see how industry supporters are responding. Basically, they are saying, or maybe just desperately hoping, "Feh! It's no big deal."

 

They were singing a different tune before the vote. As was true for the prior CEJA CME reports, MECCs (medical education communication companies) and their supporters maligned the document. The Alliance for CME, the main trade organization for MECCs, had released this statement recommending that many sentences in the recommendations be stricken—essentially any sentence that challenged the status quo.  

ACRE, a relatively new organization composed of physicians who  vigorously defend financial relationships with drug companies issued what amounted to a white paper calling for the rejection of the report. ACRE found so many things wrong with CEJA 5.0 that its critique ran three pages longer than the report itself.

A couple of weeks before the vote, Medical Meetings magazine published an editorial by columnist and MECC owner Stephen Lewis angrily attacking CEJA as being an “oxymoron” because it “seems to have forgotten the critical link that exists between ethics and evidence.”

And five days before the vote, Thomas Sullivan, the owner of the MECC Rockpointe, who writes the influential pro-industy blog Policy and Medicine, reviewed and agreed with the Alliance for CME’s position that the CEJA report be canned.

So much for the run up. Now that the report has been adopted, industry advocates appear to be quickly distancing themselves from these prior alarmist views about CEJA.

Two days after the vote, Thomas Sullivan was almost celebrating. Headlined “AMA CEJA 2011: AMA House of Delegates Approves Report – Now Emphasis on Value of CME in Patient Care,” his post was nonchalant. Far from seeing this as a threat to industry funding, Sullivan now argued that the report “merely reflects an alignment of AMA policies on CME with the ACCME, HHS OIG, and the PhRMA and AdvaMed Code of Ethics.  Commercial support of CME will still remain a valuable resource for CME providers to help keep physicians up to date on the latest breakthroughs and treatments.”

Medical Marketing & Media, a publication financially dependent on pro-industry stakeholders, published an article that appeared to be journalistic coverage of the decision but which was essentially an editorial saying "don't worry, be happy." The article emphasized that CEJA 5.0 does not call for an “all out ban” on industry funding, but instead “places the moral onus on physician presenters to disclose to learners their financial interests in the topic they are speaking about.”

Derek Warnick, an industry CME director and blogger, responded with an entertaining and thoughtful post in which he concludes that “If I had to guess (OK, I don’t HAVE to guess, but I’m going to anyway), I would say that CME providers may be asked to provide a little more documentation about faculty selection and conflict resolution processes, but I don’t anticipate any major shake-ups.” 

Meanwhile, the only person whose opinion anyone cares about has remained silent. That would be Murray Kopelow, the director of ACCME. If you email ACCME for his response (as I did) you will receive the following official statement: “We are currently reviewing the CEJA Recommendations and the Board of Directors will be deciding on any next steps.” The next board meeting is July 21 in Chicago, so we will probably not get any response until they publish their Executive Summary of that meeting, probably a month or so after it occurs. 

Meanwhile--into the void--let the spinning continue. 

The Buzz from BusinessWeek

BusinessWeek's article spotlighting the problems with industry-funded CME has generated a fair amount of reponse, mostly from Medical Education Communication Companies or their surrogates. Here's a round up.

Policy and Medicine begins with a personal attack on me:

"Political fallout from the Pfizer decision not to fund medical communication companies (MECC's) in July, includes a Business Week article titled: Teaching Doctors—or Selling to Them? This is basically a rehash of the Pfizer MECC decision along with some free PR for Danny Carat, MD, the gadfly anti MECC blogger (who by the way has no conflicts of interest except that his CME newsletter business will increase if he gets his way and ends commercial support of CME – oh, yeah, he forgot to mention that in the article – such a slip). In the interview for the article Carlat is quoted of the Pfizer decision: “It sends out a message that there’s a level of distrust about the way they (the marketing firms) operate.”"

See the attack? He misspells my name! But beyond that, he accuses me of trying to hide the fact that I publish a CME newsletter and that I make money from it. Actually, I told the reporter about the newsletter, and she and her editor chose not to include the information in the article. So blame BusinessWeek, not me, and feel free to send a letter to the editor to that effect; I'm quite certain they would publish it.

To those who believe that I try to hide my involvement in the CME business, I suggest you shift your gaze slightly to the right of this paragraph, where you'll see that I disclose this conflict of interest, in bold, on the front page of my blog. You'll find no such disclosure on the home page of Policy and Medicine, however. As it turns out, the writer of that blog is none other than Thomas Sullivan, who is the founder and CEO of Rockpointe, a very successful pharmaceutically-funded MECC that produces dozens of industry-supported symposia, primarily in the field of cardiovascular disease. Their website makes the following pitch to drug companies: "We deliver message-driven medical education programs targeting the confluence of medical science and clinical need." Hmmm. "Message-driven medical education." That sounds almost like a marketing line to me. But no, it can't be, because Rockpointe is a CME company, not a marketing company, right?

It is possible to discover Mr. Sullivan's conflicts from his blog, but you'll have to scroll to the bottom of the page and click "about". If he is so concerned about conflicts of interest, why doesn't he reveal his own conflicts on his home page, like I do?

Ditto for a number of people who posted negative comments about the BusinessWeek article. A certain "J Stotler" has (thus far) posted no fewer than five comments about how "deceiptful" the article is. Who is he? He is apparently Jonathan J. Stotler, MAOM, senior director, Institute for Advanced Health Education, Union, N. J. Mr. Stotler was recently quoted in this Medical Meetings Magazine article.

Then there is Lew Pinsker, who accuses Weintraub of neglecting "due journalistic diligence in researching her subject." Mr. Pinsker fails to disclose that he is the Vice President of Editorial and Creative Services for Medical Communications Media, an industry-funded MECC that sells drug companies a product called "The Primary Care CME Synergy Plan" which "provides a consistent educational message by using a single faculty and set of learning objectives...." Gee, "consistent educational message." Marketing? No, must be CME.

But wait--there's more!

B. Martin criticizes Weintraub's "inability to differentiate between outright pharma marketing and the current status of industry-funded CME." She does not disclose that she is Barbara Martin, who, on her Pathophilia website, identifies herself as a "formerly practicing board-certified neurologist" who is now a full time writer in the "intriguing world of pharmaceutical marketing and pharma-supported continuing medical education (CME)." I guess that means her job is dependent on industry support of CME.

We all have our conflicts of interest, and our conflicts inevitably inform our opinions. However, to those who base their arguments on attacking my conflicts, please make sure to disclose your own.