Archive for November, 2009
CME in the News and on the Blogs September 23rd- 27th, 2009
ACCME Board to Consider Disclosure Policy at December Meeting
MeetingsNet Nov 24, 2009
“ACCME board of directors to discuss increasing transparency around its complaints and inquiries process.
The Accreditation Council for Continuing Medical Education’s board of directors will discuss making changes to its process for handling complaints and inquiries about accredited providers at its meeting December 3-4. According to ACCME’s chief executive, Murray Kopelow, MD, “the board is considering the full range of issues involved for both the accreditor and the CME provider” once a complaint has been filed that a provider is not in compliance with the ACCME’s 2006 Accreditation Criteria. This includes whether or not to make public certain information about activities and providers who have been found to be noncompliant. This information currently is released only to the complainant and the provider charged with noncompliance.”
(Authors Note: It is not only the US that is grappling with the issue of industry relationships with health professionals. Here is an article from our colleagues in Australia.)
Mandatory Disclosure of Pharmaceutical Industry-Funded Events for Health Professionals
Robertson J, Moynihan R, Walkom E, Bero L, Henry D (2009) PLoS Med 6(11): e1000128. doi:10.1371/journal.pmed.1000128
Summary Points
• There are moves internationally to ensure greater disclosure of gifts and educational events for doctors paid for by pharmaceutical manufacturers. However, there is no agreement on appropriate standards of disclosure. In Australia, since mid-2007, there has been mandatory reporting of details of every industry-sponsored event, including the costs of any hospitality provided.
• Examination of the Australian data shows that although expenditure at individual events is often modest, cumulative expenditure is high, particularly in the case of medical specialists prescribing high cost drugs—oncologists, endocrinologists, and cardiologists.
• Although a significant advance, the new Australian reporting standards do not allow assessment of the educational value of sponsored events, and do not include details of speakers or educational content for most events. However, doctors in training are often present at these events.
• At present, the standards of disclosure are inadequate and should not be tied to an arbitrary monetary value of gifts or sponsorship. Reporting standards should require the names of the speakers presenting, whether sponsors played a role in suggestion or selection of speakers or the development of the content of presentations, and the nature of any direct or indirect financial ties between the speakers and the sponsors.
A useful resource for those investigating the pharma industry
Croakey the Crikey HealthBlog, November 27th , 2009
“The Drug Industry Document Archive contains over 2500 documents about pharmaceutical industry clinical trials, publication of study results, pricing, marketing, relations with physicians and involvement in continuing medical education. It is a publically accessible web site hosted by the University of California, San Francisco Library and Center for Knowledge Management
Most of these previously secret documents were made public as a result of lawsuits against the following pharmaceutical companies: Merck & Co., Parke-Davis, Warner-Lambert, Wyeth, and Pfizer………………….”
Add comment November 28, 2009
CME in the News and on the Blogs November 18th- 21st
U.S. Sen. Grassley: Continues effort for transparency about drug company money
Iowa Politics.com 11/19/2009
“Senator Chuck Grassley has asked leading medical schools to describe their policies on ghostwriting as part of his continuing effort to shed light on financial ties between the pharmaceutical industry and medical professionals.”
ACCME Pondering New Complaints and Inquiries Policies
Medical Meetings – MeetingsNet.com Nov 18, 2009
“While Murray Kopelow, MD, chief executive of the Accreditation Council for Continuing Medical Education declined to answer specific questions about his announcement in an article recently published in The New York Times that ACCME would “make public ‘within weeks’ a previously confidential listing of classes and companies that violated rules against commercial bias,” ACCME did release a statement last week saying it is continuing to deliberate the issue as part of its mission to increase transparency around the accreditor’s actions and policies.”
Add comment November 20, 2009
CME in the News and Blogs November 16th -21st
Authors Note: Here is one written by a former medical writer.
Continuing Medical Propaganda Education
Majikthise
November 16, 2009
“A little known provision in the House health care bill would require the $1 billion continuing medical education (CME) industry to disclose more about what it’s teaching the nations doctors.…………
At a time when the future of health reform depends on cost control, it might not be such a good idea to let pitchmen educate doctors.
More transparency in the CME industry can only be a good thing. The public might not like what it sees.”
A Grassley Nemesis and His Ties to Pharma
Pharmalot,
November 17th, 2009
“Who is Thomas Sullivan and why is his name popping up lately? Sullivan is known for a few things – president of Rockpointe a medical education communications company; a founding member of the Association of Clinical Researchers and Educators, and his Policy and Medicine blog, where he rails against government oversight of the pharmaceutical industry. Besides being an avid defender of CME, he is also a vociferous critic of Chuck Grassley, the Senate Republican who is investigating various pharma issues, including CME.
Over the past few days, however, Sullivan has been scrutinized himself………”
Read More:
SACME Responds to CEJA ReportP Financial Relationships with industry in CME
November 2, 2009
ACCME transparency looking a little opaque to me
Medical Meetings – MeetingsNet by Sue Pelliter, November 19th, 2009
“OK, I admit I was a little miffed to learn we had been scooped on our own turf by The New York Times when that venerable paper reported that the Accreditation Council for CME was going to be publicly outing accredited providers who were found to be in violation of its accreditation criteria. But really, shame on me for not jumping on the story first, I thought.
But now I am doubly miffed. After waiting for weeks for an interview, then at least some e-mailed comments, yesterday ACCME Chief Executive Murray Kopelow, MD, declined to discuss with me at all what he had already told the Times, much less answer any follow-up questions I sent. They did issue a statement last week that, to me anyway, didn’t say a whole lot (here’s the best I could do to provide an update, based on the information in the statement)……………..”
NOTE: Sue did post a little later to say, “Dr. Kopelow is going to talk with me this afternoon. I know he likely won’t be able to give me many details, but I look forward to hearing whatever he can say, and will share it with you as soon as I can.” Watch her Blog for the update.
Add comment November 20, 2009
CME in the News and Blogs November 7th – 13th
University of Miami hires controversial expert
The UM medical school hired a psychiatrist who has been criticized for taking millions of dollars from drugmakers.
Miami Herald, November 6th, 2009
Charles Nemeroff, an Atlanta psychiatrist who was the subject of a Senate investigation concerning huge sums he received from drug companies, has been named chairman of the psychiatry department at the University of Miami.
Last year Nemeroff, as the top psychiatrist at Emory University, was the focus of an investigation by Sen. Charles Grassley, R-Iowa, who said he was concerned about the millions the psychiatrist received from drug companies while conducting supposedly unbiased research for the National Institutes of Health on drugs made by the companies he was receiving money from.
Are You Systematically Engaged in Performance Improvement in Your CME Operation?
Conversations n CME , November 8th, 2009
“Most CME providers I talk to are not engaged in a systematic, sustainable, repeatable effort to improve their own CME operation. What better place to learn how to develop improvement skills in our customers than to engage in improvement efforts in our own CME operation?”
CME must be untainted — no matter who’s paying
American Medical News, Ethics Forum. November 9th 2009
Scenario: Should physicians pay for their own continuing medical education to avoid ethical entanglements?
Reply:
“CME has long been subsidized by pharmaceutical companies and medical device manufacturers. Over the last decade, that funding source has generated increasingly intense ethical debate…………….”
Reply:
“Has CME come to stand for commercial medical education? Many physicians recognize that the curriculum and content of continuing medical education are largely determined by those who pay for it.”
“We currently face a rather fierce debate on the question of who should own the CME agenda. No one would suggest that the only education physicians receive after leaving residency training should be in “product placement” or in understanding disease categories created to serve marketing needs. Yet many CME activities, as well as our professional associations, are heavily dependent on drug makers’ and device makers’ funding……………”
AMA CEJA 2009: Report Financial Relationships with Industry in Continuing Medical Education Referred Back to Committee for the Third Time by AMA House of Delegates
Policy and Medicine, November 9th, 2009
“American Medical Association House of Delegates referred back to committee the Council on Judicial and Ethical Affairs report Financial Relationships with Industry in Continuing Medical Education referred to as CEJA 1. This is the third time it has been sent back for more work by the AMA House of Delegates.”
Why is the American College of Rheumatology barring the media from adding CME?
KevinMD.com Medical Web Blog, November 9th, 2009
by Robert Stern, MA, CCMEP
“In our continuing saga with the American College of Rheumatology (ACR) and their oppressive media policies, one of our readers kindly forwarded a letter received by her from the president of the ACR who provides his justification for attempting to restrict MedPage Today’s access to their annual meeting.”
Health-Bill Disclosure Rule Is Resisted
At Issue, Drug Makers’ Sponsorship of Doctors’ Continuing Education Classes
By Alicia Munday.
Wall Street Journal November 13th, 20029
“Health legislation moving through Congress would force drug makers to disclose how much they spend on continuing medical education classes for doctors, sparking some resistance from the industry. “
How Industry Spends $1 Billion a Year on Continuing Medical Ed.
Wall Street Journal Health Blog by Alicia Munday, November 13th. 2009
“Drug and device companies, along with other industry players, spend about $1 billion a year to fund the continuing medical education classes doctors have to take to keep their licenses current. We may soon get more insight into how that money flows: A little-discussed provision in the House health care bill would require drug makers to disclose their spending on CME, the WSJ reports.
Sens. Herb Kohl and Chuck Grassley have been interested in this sort of thing for a while — and they’ve been the target of some critical blog posts by Tom Sullivan, the owner of a CME company called Rockpointe.
His blog caught the attention of Kohl’s Special Committee on Aging, which requested records of payments from the health-care industry to Sulllivan’s company. You can read the list for yourself — it adds up to more than $20 million since the start of 2006.”
Tom Sullivan, of ACRE FAME, is Swimming in Drug Company Cash
The Carlat Psychiatry Blog, November 12, 2009
Wherever there is a vocal battalion of defenders of drug industry funded medical education, you are certain to find Tom Sullivan leading the charge. Sullivan writes the most prolific pro-industry CME website, Policy and Medicine. He is a founding member of ACRE, and managed all the logistics for ACRE’s first embarrassing meeting, held at Brigham and Women’s Hospital. He collaborates closely with John Kamp, director of the pro-commercial CME front group, Coalition for Healthcare Communication.
Add comment November 16, 2009
Are You Systematically Engaged in Performance Improvement in Your CME Operation?
My brother has worked industry for over 30 years. Many of those years he has been directly engaged in improvement initiatives. Now, in his own business, he works with many types of enterprises, including healthcare, helping them identify and engage in ways to improve their operations. He also teaches these skills to students in a business college in the Midwest.
In training situations he is fond of asking those in attendance, “How many of you had a perfect day at work yesterday? A day in which everything went perfectly where there were absolutely no problems, no issues, zero hassles”. You know, not one person has ever raised their hand saying that was my day. Then he asks this, “How many of you went to work yesterday with the intention of doing a bad job?” Again, no one raises their hand. Then he asks, “How many of you are engaged in a conscious effort to improve or start improving something that went wrong at work yesterday?” Again there are no hands raised. What does this say about how we approach our work? Everyday we can count on something going wrong. We do not go to work everyday intentionally to do a bad job. Yet, everyday we do nothing systematically to improve our work world.
Our customers, those we serve in CME, are required to engage in improvement efforts to earn CME credit. They have to be engaged in efforts to improve their capability to practice (competence), their actual performance, or the health status of the patients they care for. As an ACCME accredited provider we have to measure those improvements.
Most CME providers I talk to are not engaged in a systematic, sustainable, repeatable effort to improve their own CME operation. What better place to learn how to develop improvement skills in our customers than to engage in improvement efforts in our own CME operation?
Here is an invitation. My brother (the one I mentioned earlier) is going to work with me on this. We are looking for five people interested in learning, and then participating in a four month pilot test of a systematic sustainable, repeatable approach to improving their CME operation. It is also an approach you can teach physicians to use in PI CME or any improvement initiative in their practice setting. We will learn this approach by participating in a series of four one hour discussions on Go To Meeting. No charge to you. After the orientation, we will use a page created Facebook to communicate our progress, ask questions, share experiences, and, ultimately share our outcomes. If you would like to participate in the pilot project contact me at ctlassoc@mindspring.com.
I firmly believe that if we adopt this approach to improvement we can transform a CME operation, we can provide physicians an effective approach to improvement efforts in their practice, and we can generate data demonstrating that our CME program is a strategic asset in our organization.
Add comment November 8, 2009
CME In the News and Blogs: Week of November 1st, 2009
OK. I admit it. To get something other than the evil influence of industry on continuing medical education or some congressional hearing examining pharma payments to physicians, or a crack down by ACCME on non-complaint CME providers related to commercial support or disclosure, etc., I put my own Blog entries in this weeks summary. Maybe this brief diversion will get some of us thinking about how we can do a better job of serving our physician constitutes and continuously improving our CME operation.
CME Providers: Adopt an Improvement Program in Your CME Operation.
Conversations in CME October 31, 2009
Accredited CME providers are required to measure change (improvement) in physician competence, performance or patient outcomes. What does this mean? It means CME providers are expected to be integrally involved in health care quality improvement. I think the best way to learn how to be effective in this improvement environment is to adopt a “culture of improvement” in our own CME operations.
Read More:
A National Model to apply to our Overall CME Program Improvement?
ACCME requires all accredited CME providers to “Evaluate the effectiveness of its overall CME program and make improvements to the program” (Element 2.5). So how do we do this improvement stuff? I hear this question asked over and over. I hear interesting variations in the interpretation of what this means. We can change that ambiguity. We can adopt a common approach to program improvement.
NOTE: This isn’t a news or blog item but if you are interested go muck around in YouTube with search terms we might find interesting as CME providers. Here is one I found by entering “physician performance improvement”.
The Role of Physicians Performance Measures in Quality Improvement
Renal Physician Association www.renalmd.org
You tube contributes to help physicians understand performance improvement.
OK. Back to what is important. Ranting about pharma involvement in CME. Here is another one for you.
Aren’t You Glad Your Doctor Completed Pharma’s CMEs?
For OpEdNews: Martha Rosenberg – Writer, Sunday Nov. 1st.
“Raise your hand if you’ve breathed a sign of relief seeing your doctor had a CME certificate next to the medical school diploma on the wall………….
CMEs are supposed to be monitored by the Accreditation Council for Continuing Medical Education (ACCME) but like Standard and Poor’s and Moody’s stock ratings funding comes from the client side so buyer beware.
Did your doctor pass, Bipolar Disorder: Individualizing Treatment to Improve Patient Outcomes, Part 2 “taught” by Trisha Suppes, MD, PhD and offered by CME Outfitters?
Suppes is a Professor in Stanford’s Department of Psychiatry and Behavioral Science and funded by Abbott, AstraZeneca; GlaxoSmithKline, Janssen, Novartis, Pfizer, Wyeth, Bristol-Myers Squibb, Eli Lilly, Shire and four more pharma companies.
Author Note: While this is not a CME related article, this points to another reason there is continuing mistrust surrounding alleged relationships between pharma and physicians.
Amgen sued by US states over alleged “kickback scheme” for Aranesp
First WordSM
Mark Todoruk October 30, 2009
Amgen is facing a lawsuit in the US over allegations that the company offered kickbacks to medical providers to increase sales of Aranesp (darbepoetin alfa), the New York Attorney General’s office announced. The litigation, launched by 14 states and the District of Columbia, contends that Amgen conspired to offer incentives, such as weekend retreats and nonexistent consultancy agreements, to increase prescriptions for the product.
New York Attorney General Andrew Cuomo also explained that the lawsuit accuses Amgen of encouraging the healthcare providers to seek reimbursement from third-party payers, including Medicaid, for supplies of the anaemia drug that they obtained at no cost. The multi-state legal action joins a whistleblower complaint filed in another federal court in 2006 over allegations that Amgen illegally marketed Aranesp.
In response to the latest news, Amgen commented that it believes “the allegations are without merit.”
CME Reform from People Who Don’t participate in CME.
Pathophilia By bmartin on November 3, 2009
There is a particular irritation to be found in the criticism of continuing medical education (CME) by a nonphysician. There is even more irritation to be found in the criticism of CME by a purveyor of sociology. There may be practical benefits of the so-called science, but its merits have eluded me in a life that’s had its fill of academia.
In the latest issue of JAMA—a journal becoming known for its overbearing editorials—sociologist Eric Campbell, PhD, and health economist Meredith Rosenthal, PhD, condemn the current state of physician CME by applying general critiques from the landmark Flexner Report of 1910. They also advocate investment in something they call “physician human capital,” a term adapted from economists to convey the medical knowledge and skills that are required to provide “high-quality, efficient, and cost-effective care.”
Editors Note: I kinda like this assessment.
Add comment November 6, 2009
