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Recent: CME in the News and Blogs

CME in the Recent News

If you subscribe to the illogical conclusion that the most important things in CME are the things that get press and blog coverage then you will find the most important thing in our industry is the relationship between industry and the healthcare community. Here are some recent examples of what I mean.
U.S. Sen. Grassley: Says drug companies should disclose payments, seek greater transparency

IowaPolitics.com
Friday, October 23, 2009

WASHINGTON — Senator Chuck Grassley is continuing his campaign to establish transparency with the financial relationships between drug companies and medical professionals.

Grassley has conducted oversight and sought disclosure with physicians, especially those involved in influential taxpayer-sponsored medical research; medical journals containing ghostwritten articles; medical colleges; continuing medical education; and the patient advocacy community.

CME outfitters: Guilty of Pro-Seroquel Bias, According to ACCME

The Carlat Psychiatry Blog
Monday, October 12, 2009

In ACCME’s testimony before the Senate Special Committee on Aging on July 29 of this year, Dr. Murray Kopelow, the chief executive of ACCME, defended the integrity of the embattled organization in part by pointing out that they have beefed up their enforcement of anti-commercial bias policies.
Here is a story that exposes an accredited provider for alleged non-compliance.

ACRE Responds to CEJA Report Financial Relationships with Industry in Continuing Medical Education

Policy and Medicine
October 19, 2009

The Association of Clinical Researchers and Educators (ACRE), recently released their response to the AMA CEJA Report: Financial Relationships with Industry in Continuing Medical Education (1-I-09). Specifically, ACRE recommended that AMA House of Delegates reject the report or refer its recommendations back to committee. The report which includes some light editing from the report rejected by the House of Delegates this past summer needs to be rewritten from the beginning.

Merck discloses a portion of US speaker fees

Medical Marketing & Media
October 20, 2009

Merck disclosed fees paid to US-based medical and scientific professionals who spoke at promotional medical education programs during the third quarter of 2009.

The first disclosure includes payments made to 1,078 patients between July 1, 2009 and September 30, 2009. Speakers during that period were paid an average of $1,548 per engagement, and participated in two engagements on average, according to the announcement. The company will disclose payments for the third and fourth quarters of 2009 in early 2010, at www.merck.com/speakerpayments.

Extremely Low Rates of Bias Reported in Commercially Supported CME Activities

Policy and Medicine
October 20, 2009

The American Journal of Medicine (AMJ) recently produced a critical study titled: “Low Rates of Reporting Commercial Bias by Physicians Following Online Continuing Medical Education Activities.”

The study of over 1,000,000 physician CME participants, found very little reporting of bias (less than 1%) and no difference between bias reported in commercially supported vs. non supported CME activities.

The study was funded by Medscape, LLC, and written by employees of Medscape, and other authors who give a complete list of their disclosures in the article.

Drug Companies Used Physician Education to Push Pills

Brian Vastag Science Journalist
October 20, 2009

Article Authors Note: A scientific journal recently commissioned this story from me, but after I reported and wrote it, the journal killed it. I think it’s an important story that serves the public good, so I’m posting it here to get it on the record. BV

Drug makers routinely exploited continuing education seminars as opportunities to market pills to doctors, company documents reveal.

Continuing medical education (CME) has exploded into a $2.3 billion business in the United States, with nearly half of the funds pouring in from drug and medical device manufacturers. Physicians must complete a certain number of CME courses each year to retain their medical licenses.

Today, the large pharmaceutical companies say their CME dollars support only independent education, with no input from the companies. But as recently as 2004, the documents show, marketing personnel played key roles in developing the seminars, treating CME as one element of their comprehensive sales plans.

“It is very clear…that continuing medical education has been used as marketing, and I think it continues to be,” said Allan Coukell, director of the Pew Prescription Project, which seeks to reduce or eliminate conflicts of interest in medicine.

CME accreditation body plans exposure of courses violating drugmaker influence rules

FierceHealthcare: Daily News for Healthcare Executives
October 21, 2009

To remain certified, doctors must take continuing medical education courses each year. With about half of the $1 billion per year cost of these courses being picked up by pharmaceutical companies, questions have always lingered as to whether such sponsorships unduly influence physicians. That’s particularly the case, critics say, because the nonprofit that accredits course providers–the Accreditation Council for Continuing Medical Education–hasn’t done enough to police drug industry influence on such content.

This week, however, the accrediting group has signaled that it’s ready to take a tougher stand on the issue of pharma influence on CME content. The head of the ACCME said this week that he would soon be revealing a list of classes and companies that already have violated rules against imposing commercial bias on this content.

Add comment October 26, 2009

A Call for a Standard Approach to PI CME

The American Medical Association has approved a framework physicians can use to engage in performance improvement and earn CME credit. The framework is useful but guidance for how to engage in effective performance improvement initiatives that will result in sustainable change is missing in the framework. In fact, the simplicity of the model may be a disservice to the physician wanted to engage in effective performance improvement efforts. But there is a solution. The solution is to adopt a nationally accepted standard for the implementation of PI CME initiatives. I think is a good idea.

Continue Reading 3 comments September 27, 2009

GSK and CME Funding Restrctions

This story has created a torrent of interest in the blogs and news outlets in the past few days. Google “GSK and CME” and you will see what I mean. This is yet another of the great number of stories we have been seeing for a long time related to industry involvement with CME. It seems to be the major topic of interest to writers and bloggers following CME issues.

GlaxoSmithKline Changes Doctor Training Policy
Associated Press – Sep. 21, 2009

RESEARCH TRIANGLE PARK, N.C._British drugmaker GlaxoSmithKline PLC is making major changes in its spending on training programs for doctors, fees paid to doctors for consulting, and even political contributions.

The changes include immediate bans on all corporate political contributions and on using commercial medical education and communication companies to run programs teaching doctors about medical treatments.

Those programs often promote a drug maker’s new, generally expensive drug and give little information about its risks or how well it compares to older, cheaper drugs.

The moves come as congressional investigators, consumer groups and the media ratchet up criticism over the increasing influence drug and medical device makers wield over the practice of medicine.

Add comment September 23, 2009

CME in the News Week of August 31st, 2009

Over and over the majority of the news items appearing in blogs, web news outlets, newspapers, etc. focus on questionable practices of pharma involvement in CME. This week Pfizer and Forest Laboratories get the attention. ACCME got a little attention this week. So you want to see what the public is hearing about what we spend our time doing? Lots of fodder for the anti-pharma involvement in CME proponents.

The ACCME Data Dumps
By bmartin on August 31, 2009 4:14 PM

Last Thursday the Accreditation Council for Continuing Medical Education (ACCME)—the organization that accredits other organizations to provide certified CME in the United States—released detailed data on 729 providers. In an e-mailed press release, the ACCME’s Chief Executive, Murray Kopelow, stated that these data were being made public in an effort to “increase the system’s transparency and accountability.”

Among the accredited providers, 124 (17%) received the designation of “Accreditation with Commendation” from the ACCME; 16 received commendation under the more stringent 2006 criteria, which is intended to foster providers’ participation in “institutional or system-wide initiatives” to improve the quality of healthcare (whatever that entails exactly).

Documents Show Lexapro Promoted By Tens Of Millions In Doctor

Lunches, Lectures
“Forest’s 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.
“Under ‘Rep Promotional Programs,’ the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers over the course of one year.

“An entire section of the marketing plan, titled ‘Continuing Medical Education,’ outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.”

Forest’s Promotional Objective: Use CME to Sell Lexapro
The Carlat Psychiatry Blog
September1 2009

“We have known for some time that the actual purpose of industry-sponsored CME (continuing medical education) is to increase prescriptions of the supporter’s product. But few will admit it. The ACCME says that it accredits only CME that is unbiased and objective, even though half of it is paid for by the pharmaceutical industry. Leading medical societies appear to be willing to fight to maintain their God-given right to industry funding of CME until the world ends.”

Document Details Plan to Promote Costly Drug
By GARDINER HARRIS
New York Times.
Published: September 1, 2009

Here is a paragraph in the article you should take note of:

“An entire section of the marketing plan, titled “Continuing Medical Education,” outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.”

Mother of God! Forest Labs Had Marketing Plan for Lexapro!
By bmartin on September 2, 2009 12:49 PM

“And gambling occurs in casinos. Yesterday Gardinar Harris of the NYT revealed that Forest Laboratories, the maker of the antidepressant escitalopram (Lexapro), had a 2004 marketing plan for the drug. Harris’s article,* which is made possible by government access to what was a confidential document from Forest, seems intended to generate a considerable amount of righteous indignation. But a review of the abridged plan, which is made available here, reveals nothing more than the usual strategies and tactics by pharma to achieve or maintain a drug’s market share—objectives that are, in fact, a company’s responsibility to its shareholders. Frankly if Forest’s Lexapro marketing team, circa 2003, is to be publicly chided, it should be for lack of originality.”

Drug company paid MN doctors $754,127: Forest Laboratories paid 62 Minnesota doctors in 2008, a nonprofit group reports.
By JANET MOORE, Star Tribune
Last update: September 3, 2009 – 12:57 AM

“Minnesota doctors were paid thousands of dollars in speaker fees and other payments last year by a pharmaceutical company now implicated in a congressional investigation for its aggressive promotion of a popular antidepression drug, according to documents filed with the state and analyzed by a nonprofit group

“Forest Laboratories Inc. paid 62 Minnesota doctors at least $1,000 each in speakers’ fees, with 28 physicians receiving payments of more than $10,000, according to The Pew Prescription Project. All told, Forest paid Minnesota practitioners more than $750,000 in 2008.”

To check out drug company payments to doctors, go here.

Pfizer Reaches Record Settlement with Feds; Yes, That Is $2.3 Billion with a ‘B’
By Douglas B. Farquhar –
September 2, 2009
FDA Law Blog
Hyman, Phelps & McNamara, P.C.

“…the marketing acts that allegedly resulted in the false claims for federal reimbursement included the following:
• The marketing team positioned Bextra for uses other than the approved uses, created and tested sales materials promoting those uses.
• The sales force marketed Bextra for unapproved uses, including drafting and distributing physician standing orders and hospital pain “pathways” that called for unapproved uses of Bextra.
• Pfizer and Pharmacia used “so-called” Advisory Boards, consultant meetings, and other forms of remuneration to promote Bextra for unapproved uses (Advisory Boards have been a particularly frequent target for federal government investigations).
• The sales force created sham requests from physicians for off-label information (the requests are supposed to originate from physicians without prompting from sales representatives).
• Distribution of drug samples for unapproved uses.
• Sponsoring supposedly independent CME (continuing medical education programs) that were not independent.
• Initiating, funding, and occasionally drafting articles for medical publications about unapproved uses of Bextra.”

Pfizer to Pay $2.3 Billion, Undergo Annual Reviews for Off-Label Promotion
FDA News, Volume 6, Number 173, Friday September 4th 2009

Pfizer has agreed to a $2.3 billion settlement — the largest healthcare fraud settlement in Justice Department history — to resolve criminal and civil cases arising from the illegal promotion of several of its drugs. As a result of the investigation, the drugmaker is entering into a five-year corporate integrity agreement with the HHS Office of Inspector General that requires annual reviews of the company’s compliance program. Pharmacia & Upjohn, a Pfizer subsidiary, will plead guilty to a felony violation of the Food, Drug and Cosmetic Act for misbranding the anti-inflammatory drug Bextra (valdecoxib) with the intent to defraud or mislead and will pay $105 million in fines, Justice said in a press briefing Wednesday.

Big Pharma Paying Doctors to Promote Drugs: Where is the Line?
FindLaw’s Common Law

“…….. record-breaking fines against Pfizer offer an opportunity to examine recently surfaced information regarding marketing tactics employed in the pharmaceutical industry. Though the line is not always clear, the Pfizer settlement agreement shows that federal prosecutors believe many widely used marketing tactics to be illegal.”

Add comment September 4, 2009

CME on the Web: Week of August 20th

So here is a sample of what is on the web and in the news abut CME this week

What do you know -a “good news story on the Web about one of our own.

Continuing Medical Education with Poetic Style: Outcomes Inc. Founder & President Grows Successful Business and Finds Fulfillment in Poetry

As president of Outcomes Inc.—an $9 million business focused on continuing medical-education assessment—and a published poet, Linda Casebeer has proven that taking risks and persevering are keys to success. Her experiences in the start-up phase of her business are valuable to any entrepreneur looking to overcome initial hurdles. Whether seeking business success or personal fulfillment in artistic expression, Linda’s journey is one of full of satisfaction on many levels.
<a href="“>Read More:

How to make industry influence transparent in continuing medical education

Medical Weblog. KevinMD.com
August 25, 2009

Here is how this one starts:

“A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don’t need to be a Washington policy wonk to discover that there’s a huge problem with CME.”

CME In Web News Week of August 17th, 2009

Here is some of what the public is reading about CME in the papers and on the web this past week.

From the Web Page of the Senate Committee on Aging

KOHL HEARING CONSIDERS EFFECTS OF BILLIONS IN DRUG, DEVICE FUNDING ON MEDICAL EDUCATION IN AMERICA July 29, 2009

The report begins:

“The U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing on conflicts of interest in medical education. In recent years, the pharmaceutical and medical device industries have increased their funding of Continuing Medical Education (CME), medical schools, and professional medical associations. The industries also pay physicians directly for their service as educational consultants. According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion between 1998 and 2006.

“Large corporations do not typically spend these sums unless they think they will get something out of it,” said Chairman Kohl. “Are the drug and device industries getting a return on their annual billion dollar investment in medical education? Do the programs funded by industry stay true to their mission of providing unbiased education and research, or do they instead market the industry’s latest products? We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered.”

Medical schools and drug companies too cozy
Milwaukee Journal Sentinel
Last update: August 18, 2009 – 3:19 PM

The University of Wisconsin CME office takes another slam from the press. Here is the last paragraph of this article.

“The University of Wisconsin’s good name has been tarnished by this money-grubbing enabling of a drug company’s marketing campaign. In recent months, the school has taken steps to establish tougher conflict-of-interest rules. But UW hasn’t moved to limit continuing medical education payments from industry, which may be an even larger risk to its reputation.”

Senator Moves to Block Medical Ghostwriting
By NATASHA SINGER
New York Times
Published: August 18, 2009

Many CME providers have experienced the practice of “ghostwriting”, especially in the preparation of enduring materials. The practice is under fire.
A growing body of evidence suggests that doctors at some of the nation’s top medical schools have been attaching their names and lending their reputations to scientific papers that were drafted by ghostwriters working for drug companies — articles that were carefully calibrated to help the manufacturers sell more products.

JAMA
Vol. 302 No. 7, August 19, 2009
Industry Support and Professional Medical Associations

Letters published from several people in response to the JAMA article appearing April, 2009 calling for drastic changes in industry support for medial education.

Full access to these letters requires a subscription to JAMA, But here is the first part of several of the letters.

To the Editor: In their Special Communication, Dr Rothman and colleagues1 noted that “extensive literature has documented the influence of gifts on individual physicians.” To my knowledge, there is no similar evidence showing that commercial support of continuing medical education (CME) has the same influence, either on physicians or on their professional medical associations (PMAs).

The best current evidence is a study commissioned by the Accreditation Council for Continuing Medical Education (ACCME) and not published in the peer-reviewed literature.2 Additional high-quality evidence in this area would add to this already valuable national discussion.

It is critical to recognize the implications of the difference between relationships of individual physicians with industry and grants from industry to PMA’s for independent CME. Based on the evidence, few of the authors’ recommendations follow convincingly. One which does, however, is that committees crafting clinical practice guidelines should be composed of members without ties to industry, . .

Norman Kahn, MD
nkahn@cmss.org
Council of Medical Specialty Societies
Chicago, Illinois

Industry Support and Professional Medical Associations
To the Editor: In their Special Communication, Dr Rothman and colleagues1 made a number of suggestions to control the real and perceived conflicts of interest encountered in PMAs. Regarding industry support of conferences and other educational meetings, they recommended that “each PMA might establish a CME committee whose members, free of all industry ties, would have the responsibility to distribute unrestricted, educational grants from industry.”

Such a model already exists and has been active for more than 2 years. The collaborative grants model developed by the Physicians’ Institute for Excellence in Medicine (PIEM, a subsidiary of the Medical Association of Georgia) does just that.2 Grants are solicited from industry; in turn, these are distributed through a request-for-proposal process to 14 state medical societies. A committee of physicians in each society decides which of the applications from their state should be sent forward to PIEM for a final decision. Industry plays . . .

Walker L. Ray, MD; Robert L. Addleton, EdD
bob@physiciansinstitute.org
Physicians’ Institute for Excellence in Medicine
Medical Association of Georgia
Atlanta

1. Rothman DJ, McDonald WJ, Berkowitz CD; et al. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA. 2009;301(13):1367-1372.

You may want to read the response to these letters by Dr. Rothman.

University Diaries Blog
August 18th, 20029
By Margaret Soltan who is an English professor at George Washington University, in Washington, DC.

“This money-grubbing enabling of a drug company’s marketing campaign…” … should really stop, writes the editorial board of the Milwaukee Journal Sentinel.

Especially since the grubber in question is the University of Wisconsin’s medical school, which got a million dollars from a drug company to put UW’s good name behind the company’s synthetic testosterone.
Said testosterone is not only of uncertain benefit to men older than 45; it might actually be dangerous. But its maker, Solvay, touted it on a continuing medical education website which offered CME credit to doctors who read articles on the site about it. And, since a real live university sponsored the deal, the medicine looked legit.

Industry funding of continuing medical education should be phased out to avoid conflicts, and Congress should require full disclosure of all industry payments for continuing medical education.
Phasing out industry funding of CME means phasing out CME, at least as we’ve come to know it.

Go to the blog here. or here:

Another read on this comes from an Association for Healthcare Journalist blog.

Why Most CE Courses are Dead on Delivery
By Keith Eric Grant, PhD, NCTMB
Massage Today
August 19, 2009

Here’s one from a person involved in massage. A look at some of the literature about the effectiveness of CME.

Careers in CME (continuing medical education)
Trusted.MD
8/21/2009

Here is an interesting comment on careers in CME and the future of industry support for CME. Might give you pause.

Add comment August 24, 2009

Pharma Influence in Continuing Medical Education: One Welcome Contribution

“Pharma influence in CME? What!! Are you out of your mind?”

“Well, no not really. And here is why I don’t think so.”

Continue Reading Add comment May 14, 2009

Where (How) Can We Make a Difference in the Current CME Environment?

I was talking to a colleague who happens to work in pharma asking for some advice on an issue of concern to my organization. In the conversation we wandered off to talk about the current state of our CME enterprise. He asked me an interesting question. It went something like this. Floyd, if you could position yourself in the CME world where you could make the greatest impact for positive change, where would that be? Here is my response. How would you respond?

Continue Reading Add comment May 12, 2009

Sure. Go Ahead. Ban Pharma Money From CME.

Banning commercial support for CME appears to be a moral crusade for some, but at what cost? Ask, “Where the money will come from to allow physicians to have access to CME at a price they think they can afford or are willing to spend? Why me of course. The patient. Priceless.

Continue Reading Add comment April 28, 2009

Can PI CME Effect Permanent Change? Maybe- Maybe Not!

For permanent change to occur in the practice of medicine there must be a change how the work of patient care is done. Performance improvement and systems based thinking are two sides of the same coin. KNOWING IS NOT ENOUGH.

Continue Reading Add comment April 7, 2009

Conversations In CME with Floyd Pennington