Tuesday, November 20, 2007

Nature Takes on the Biases of Pharmaceutical Sponsored CME: Is the Anechoic Effect Starting to Fade Away?

In Nature, a news article by Jim Giles focused on potential biases of pharmaceutical company funded continuing medical education (CME). We had previously posted about an illustrative case, in which GlaxoSmithKline funded speakers seemed to favor clinical policies which would promote increased use of its drug valacyclovir (Valtrex) for genital herpes infections. Giles also used that case for illustrative purposes in a sidebar entitled "Smokescreens."

Giles then described two relevant, but unpublished studies. The first was by Jatinder Takhar

Takhar and her colleagues went on to develop a standardized checklist of potential problems to be used for measuring bias in CME, which they published in June (J. Takhar et al . J. Cont. Educ. Health Prof. 27, 118-123; 2007). The team then applied its checklist to 17 company-sponsored CME events. Nine of these were found to be biased and should not have been approved, Takhar says. Some focused only on the sponsors' product and ignored rival treatments. In others, information on side effects associated with the sponsors' drugs was reduced to small print.

The second was by Daniel Carlat,

Another study, by Daniel Carlat, a psychiatrist at Tufts University School of Medicine in Somerville, Massachusetts, looked at printed CME material — typically, medical articles followed by a written test. Carlat asked his colleagues to remove information about the sponsor from exercises sent to his office during 2005 and 2006. He then calculated the ratio of positive to negative statements made about every drug mentioned in the exercises. In 14 of the 15 exercises he looked at, the drug that received the highest ratio turned out to have been made by the firm sponsoring that exercise. He is preparing his paper for submission to the American Journal of Psychiatry.

For balance, Giles asked Jennifer Page, communications director at the Pharmaceutical Research and Manufacturers of America (PhRMA), for comment, but she "said only that drug companies do adhere to her organization's CME guidelines. Those standards require a firewall between pharmaceutical firms and medical-education companies. Drug companies can recommend speakers for events, for example, but CME providers select the physicians best suited for the job and are not obliged to follow a sponsor's suggestions."

However, Jerome Kassirer, former editor of the New England Journal of Medicine countered, "that the provider-sponsor firewall is easy to subvert, because CME providers do not need to be explicitly told to produce biased programmes. 'They know that if they don't provide what the company wants then they're never going to be hired again,' he claims."

This news article is particularly significant because it opens mainstream discussion of how pharmaceutical (and other) companies can do stealth marketing in the guise of sponsored CME.

On Health Care Renewal, we have noted how local physicians may grumble about stories about the dark side of health care, but these stories rarely make it into the medical and health care literature, and hence rarely provoke widespread discussion, much less any action. We dubbed how stories like this cause no echoes the "anechoic effect." (See relatively recent post here, and earliest discussion on Health Care Renewal here.)

Now one of the foremost science journals in the world has published a major news story on commercially biased CME. Maybe now there is hope that the anechoic effect may be starting to fade away.

Note: see discussion on PharmaLot here.

ADDENUDM (21 November, 2007): see discussion on the Carlat Psychiatry Blog here.

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