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Wednesday, January 23, 2008

How the world works-should be part of med school curriculum

I am quoting this paragraph from Health Care Renewal because it is such an excellent sketch of the outrageous situation that now exists with a certain type of medication marketing that holds itself out as CME. Read about how the players in this scenario are interrelated and how everyone benefits, well almost everyone, the docs who at best gets a little wink-wink-nudge-nudge- "CME credit" are mislead and we can guess what the results might be for the patients of the docs who are mislead.

... The standard formula calls for corporate sponsorship channeled through an “unrestricted educational grant” to a medical education communications company (MECC). The MECC employs writers to prepare the “educational content,” and academic KOLs are recruited to deliver this content. The KOLs are chosen for their willingness to be “on message” for the corporate sponsor. If they go “off message” they know they will not be invited back. The talk of “unrestricted grants” is window dressing. The MECC also secures the imprimatur of a nationally accredited CME sponsor, typically an academic institution. The sponsor is paid to certify that the CME program meets the standards of the Accreditation Council on Continuing Medical Education (ACCME). Everybody turns a buck: the MECC and its staff are handsomely paid (CME is now a multi-billion dollar business); the KOLs are generously rewarded with honoraria and perquisites; the academic sponsor is well paid by the MECC; the ACCME receives dues from the academic sponsor; the audience obtains free CME credits rather than having to pay for these required educational experiences; and the corporate sponsor gets what it considers value for its marketing dollar.

I have been invited to a number of these events and with the lure of a good meal and nothing else to do I have attended more than one. There was a time when I was not aware of what the above description depicts but now I know how to follow the money.

I have written before about how the tools and verbiage of evidence based medicine can be misused (Note I am not degrading the value of honest proper application of EBM principles or the principles themselves) and the above scenario has to be about as bad as that gets .

Bernard Carroll's paragraph quoted from HCR should be part of the basic curriculum of every medical school, every nursing school, every PA school , and every residency program.

With this concise but detailed description of the anatomy of what passes for CME in mind, one would expect growing support for the Macy Foundation report which calls for the abolition of commercial interest sponsored CME but also we can expect resistance from the well funded interested parties and some of the recipients of those funds.

We find a interesting turn described in this blog posting by Dr. Carlat who knows a little about some of the aspects of commercial interested sponsored CME. He describes a meeting he attended at Harvard and the comments made there by Dr. Martin Samuels. Anyone who has heard a lecture by Dr. Samuels will be very favorably impressed and since I have heard several( and remember much of what he said) I have to take what he says seriously.

Martin Samuels describes the Macy Report as a "house of cards" made less credible by the self interest of some of the participants. He asserts that Denise Basow who was one of the organizing committee members of the Macy Report is a principal in the online medical education endeavor known at UpToDate and that the report's recommendations fit nicely with the commercial interests of UpToDate. Let me make it clear- I am not critical of the educational value or usefulness of the UpToDate product.Everything I have heard about it indicates it is a good product.

Samuels also defends one particular MECC with which he is involved, Pri-Med. I have heard his talks on dizziness and the heart and brain interrelationships at Pri-Med meetings and in those there was no promoting of any particular product and as with all of his talks they were brilliant. Maybe Pri-Med is different from the usual MECC but I have attended 3 Primed conferences ( I plan no others) and in my opinion, some of the other talks were very little disguised drug advertisements while others appeared as valid education sessions with drug promotion either absent or so subtle I missed it. I like to think I can tell one type from the other but... It should be noted Samuels did not defend MECCs in general and also called for the abolition of the quite popular satellite educational sessions that latch onto national medical meetings.

As usual things get hard to sort out but to my thinking it is clear that much of the industry sponsored medical education is nothing more than product promotion given a veneer of respectability by their affiliation with medical school KOLs and the schools themselves and the CME certification organization known as ACCME,whose credibility also is at risk.

1 comment:

james gaulte said...

Note the original form of this entry incorrectly attributed the great quote to Dr. Roy Poses who has had so many great quotes on this general topic.The author is Bernard Carroll.I corrected it fairly quickly and the original with the error post I hope is out of the tubes and in the ether.