SternViews

Whooie!!!!!!!!!

Dr. Jerome Kassirer noted angry doctor and flamboyant critic of MedEd has an editorial in The Boston Globe.

If his accuracy on point were only as reliable as his rage and anger, he might be worth listening to, and I have his personal apology letter to prove it.

When Clinical Investigators Control CME

When physicians run an organization in name or in-fact, bias issues appear relevant.

While the for-profit MedEd community has long been looked at for bias issues, it seems more likely that within MedEd, clinical investigators who run their own medical education or society ventures are a true concern. These physicians are often leaders in clinical trials and often obtain and control the funds for these operations.

Many investigators are owners and/or partners in firms that inform and educate clinicians in new drug therapies.

They often hide behind a "society type" image or a "not-for-profit" veil.

Pharma is often confused, as we all are, about the constructs of these physician-operated information channels, and as such, Pharma often supports the very organizations the new CME guidelines, Pharma industry guidelines and Pharma's own compliance/CME funding rules were created to avoid.

It seems clear that clinical investigators should not own or operate information distribution channels. 

Like the firewalls between promotion and CME, a barrier needs to be created between investigators and their ownership or leadership in organizations that are single-focused and primarily aligned with one or two therapies that exist only because funding can be obtained.

 

 

 

Update: Who Will Pay for CME?

As this dove tails with my previous post, it seems that perhaps the reasons are not lack of available training but lack of interest by the docs to become knowledgeable.

"Many doctors and pharmacists surveyed by the center said they have received only limited training in prescribing drugs.

Four in 10 doctors said they received no training in medical school on prescribing controlled substances; more than one-half received no training on identifying prescription drug abuse or addiction. Three-fourths said they had no training in medical school identifying diversion of prescription drugs for illicit purposes.

Four in 10 pharmacists say they have received no instruction since pharmacy school in dispensing prescription drugs. Almost one-half said they have received no instruction since pharmacy school in identifying prescription drug abuse or diversion of prescription drugs."

 

According to the Associated Press, physicians are not confident in prescribing many of the key drug classes.

It's hard to believe, but there it is!

Who Will Pay for CME?

Much has been argued that CME supported by industry is nothing more than a "Continued Marketing Effort." 

Let's give the critics their due, at least for a moment.  Pharma would not be funding CME if they derived no value. 

The value proposition is a long-honored measure of behavioral change. If it has value, people will buy in.

Ostensibly, Pharma's value proposition is "I'll invest in CME because it works for me in letting clinicians know what I'm selling."

What's the clinicians' value proposition?  One might say for no investment, that is for no fee learning, they come to hear the latest update on drug therapies in their specialty. 

The critics would say that with no fee attached and with industry support, it devalues the learning and biases the experience.  Also, why do physicians get for free what other professionals have to pay dearly for? Accountants, lawyers, executives, and teachers all pay for their continued learning and investment in their careers.  All fair points.

OK, let's look at that. 

Clinicians, and by that I mean primarily physicians have long been catered to by industry.  So they have been trained to accept for free what others pay for. 

But is that the reason physicians, find it difficult to pay for knowledge and career advancement, or is the subject matter, which is predominantly on "biologics, "a nice to have" rather than a "need to have?"  Can they acquire this knowledge through journals (and yes, even Pharma promotional efforts), without having to go through a formal educational process?

Interesting dilemma. We as consumers feel that our doctor should think all information is "a need to have" and not "a nice to have."

So is it that industry has trained docs to receive drug therapy education for free or is it that docs won't pay for drug therapy education.

My 30 years of anecdotal hard-knocks experience tell me docs (like everyone else) will only pay when the value proposition for them has a payback, which is why accountants, lawyers etc pay for their CE, because they can charge for the incremental skill they have learned. 

A physician cannot charge more for their lipids or diabetes knowledge. 

A physician can only maximize the value proposition (ie, make more money) in the following categories:

1. Learn a new technique or procedure.
2. Board-review training to pass boards so they can have hospital and HMO privileges.
3. State-specific requirements to maintain state licensure.
4. Weight loss medications and facial enhancement treatments, which in turn they can bill for without any reimbursement gate keeper.

So who will pay to keep our clinicians knowledgeable about new medications?

 

 

 

CME Anxiety Disorder

We all know about social anxiety disorder, but CME Anxiety Disorder could be the most paralyzing disorder.
Here are the symptoms:
If you have one or more of these symptoms please see your CME director.

1. You are constantly worried that you have left out the "standards for commercial support" statement.
2. You have a hard time falling asleep because you have not second guessed yourself at least 100 times.
3. You question the expertise of faculty who "Do Not Have A Conflict."
4. You fear that all attending physicians are really homeless and have no other place to go.
5. You think your mother was right and you are being punished by G-D because you did not become a doctor.
6. You have a commercial funder who totally understands the rules and restrictions on funding CME activities and praises you for your high standards and efforts. Then you wake up!
7. You're afraid to send invitations for dinner meetings because a spouse may call, accusing you of having an affair with their doctor spouse because they can't come to the dinner meeting.
   
8. You change jobs and cars frequently because you feel someone is following you.
   
9. You can't tell your children what your job is because the anti-pharma gang on the playground may beat them up.
10. You feel guilty about asking for a generic drug from your doctor.

NIH Employees React

As predicted NIH employees were angered by the new rules designed to re-establish the agencies tarnished record.

Most researchers go to the NIH for the prestige and connections to industry to get their research commercialized. 

Watch for the mass exodus of top names as they dial up "CareerBuilder.com."

NIH Curbs Outside Income

As discussed in earlier blogs,the NIH has decided on a plan that will affect all employees and their outside entrepreneurial involvements.

The Once Venerable British Medical Journal

The media has gone off the deep end many times.

The British Medical Journal (BMJ) tried to play with the big guns and shot themselves in the head.

Many medical journals and book authors think that they can write with impunity and with immunity.

Part of the problem here is not only did the BMJ not do their homework, but they were adamant about their accusations and broadcast them to the world.

Looking Elsewhere for an Answer II

I'll just make this a new category if there are enough examples without being redundant.

If you substitute the word Pharma for the word restaurant, Pharma rep for concierge and doctor for the word guest you get the point pretty quickly. (free registration required)
 

When you ask a concierge about recommendations for restaurants, and tours, etc you do so with a certain amount of skepticism and you should factor their recommendations in with other research you may have done. 

So too with the doctor. You know where Pharma is coming from, and as a doctor, unlike a guest, you have an added responsibility to research, question, and make your own conclusion on what drugs and/or therapies to prescribe.

We need to get off the "Poor Doctor is Naive" bandwagon and get them to be the professionals they claim to be.

 

Looking Elsewhere for an Answer

The appropriateness of a physician being paid to do promotional programs and consulting for Pharma can often be blurred to those in the business for many years.

When you look at it from the point of view of another industry clarity of its
inappropriateness becomes clearer.  (free registration required)

Once again the importance of CME, evidence based and with transparency, come through.

Let's keep going in that direction.