SternViews

A Perspective on ACCME 2004

I found a very good think piece; although written in June 2003, adds some perspective to our new rules.

ACCME Commercial Support 2004; A Message from Our Sponsor

Hot off the press, the draft statement for commercial support has been ratified and formalized by the seven ACCME parent organizations.

In other words the first major revision for CME sponsors since 1992 has now gone into effect.

As we have discussed before the changes are reasonable and more than that they finally close many of the interpretive gaps that have been challenged by many funders.

The main bug and the item that will be hotly contested and analyzed is the section on "Conflict of Interest."

This one section alone will be pored over and written about for months to come.

Simply, it is not enough for CME providers to merely state in the disclosure section that Doctor Smart has financial information to reveal.

We must follow the money trail of each speaker and determine if their other funder-compensated activities are reimbursed from budgets that could cause the presenter to be biased. Categories such as participation in clinical trials, advisory boards, consultant agreements may put the speaker in jeopardy of being "biased" when talking about specific drug therapeutic approach.

Now, I'm not going to go into detail now, but there are alternatives to allow a "compromised" speaker to still participate, but not in areas where product specific recommendations can be made.

So: a lot more burden on us and a lot to learn.

We have a transition period from now until May 1, 2005 to put systems into place.

Stay tuned, more from our sponsor later.

Medical Student Education Re-Design

I have always wondered when would medical education become patient centric rather than disease-focused.

Harvard, not letting any grass grow under its feet, has begun a pilot program that may just put the patient first.

"Eight third-year Harvard students are part of an experimental program that hopes to address those shortcomings by casting aside the traditional hospital rotation system. Rather than moving from specialty to specialty every few weeks for intensive blocks of training, they are following individual patients, wherever their conditions take them in the health care system."

If this pilot program works and not only continues at Harvard but is adapted by other schools, the greatest and most vibrant change in medical education may have just been invented.

NIH Makes a Questionable Decision

As we know, the NIH is revamping the terms of engagement that an NIH researcher may have with industry.

I believe better definition and transparency are good things and kudos to Dr. Elias Zerhouni for undertaking a major unprecedented initiative.

However, this latest report concerns me for its gravity and radical approach.

The NIH wants to suspend, effective immediately, any contracts NIH researchers have with industry.

"NIH Director Elias Zerhouni already has tightened restrictions on such collaborations, including banning any outside consulting by senior NIH officials.
The moratorium, if granted, would apply to all NIH scientists while he debates further changes. Included in the moratorium are 60 to 100 consulting arrangements that NIH ethics officers already had approved for scientists -- because one question is whether the agency is properly reviewing and approving such deals, NIH Deputy Director Raymond Kington explained."

Why is it that large organizations can only handle change by moving 180 degrees?

Critics Aside; Low Tech Can Be Useful and Cost Effective

I have my critics, which is good. Despite those critics who suggested the Bill Clinton cartoon may not be presidential and the Oprah Winfrey story was irrelevant, here goes try number three.

As we strive to bring funding budgets in line perhaps hand shadows may be a substitute for powerpoint slides.

True it does require some training, but we won't have to rent video projectors or lug computers.
Last-minute slide corrections would be a snap (pun intended), and think about audience interaction!

As far as patient education is concerned, every exam room and hospital bedside is an opportunity for a multimedia demonstration to bring the point (pun intended) home.

Sometimes you gotta laugh.

No Good Deed Goes Unpunished

Or is it no poorly thought out deed goes unpunished?

It seems that Oprah's car gifts may have a price tag after all.

Complicated deals have a way of boomeranging.

According to earlier reports, Oprah was supposed to pay the local and state sales tax on the cars. As it turns out, Pontiac did but who's quibbling? Publicity has a strange way of taking credit where it is not due.

Anyway back to the point, it turns out that income tax is the big hit, about $7,000.00.

It seems to me that when you make a big thing about being generous to those less fortunate, you take care of the details they can't.

Perhaps Oprah will still do the right thing.

Doc Hollywood

Every health-related infomercial has its medical expert backing up the commercial's message.

There are docs on TV who have represented that they invented this or that. Most of these testimonials are backed up with little data or support other than the doctor expert.

The government is trying to get their hands around the medical claims made in infomercials and, in particular, those doctors who align themselves with the product.

This type of quackery has been with us since time-in-memorium, and this seems like a reasonable approach by regulators.

Virtual Autopsy

A potentially useful teaching tool straight out of Sci-Fi.

Think about the ways we can use this interactive teaching aid in our CME activities.

Aside from holding the audience's attention, the learning can be supported by exciting visuals to enhance the experience.

I Couldn't Resist

Cure Is Out

The word "cure" seems to be a controversial topic.

Oncologists seem reluctant to use the word "cure" because, frankly, it may not be true.

"They say these things because the simple truth is, they can't tell when or if someone has been cured. Even the most widely used benchmark — being alive five years after diagnosis — has no real basis in science, experts admit."

We generally don't use this type of terminology in MedEd activities, but patient education materials should be updated to reflect these new definitions.