Wednesday, January 23, 2008

BLOGSCAN - Conflicts of Interest, CME, and MECCs

On the Carlat Psychiatry Blog, Dr Daniel Carlat reported an alternative take on the Macy Foundation report which called for the abolition of commercial funding of continuing medical education (CME). (See Dr Carlat's earlier post on this report here.)

In a seminar on medical ethics, Harvard University's Neurologist-in-Chief, Dr Martin Samuels, trashed the Macy report on the basis of, you guessed it, conflict of interest. He charged that one of the members of the conference that produced the Macy report was a top executive of UpToDate, a medical education and communication company (MECC) that makes its money by selling subscriptions, not from drug companies. Meanwhile, Dr Carlat also reported that Dr Samuels was praising yet another MECC, Pri-Med, for which he happens to direct a neurology course.

You can't tell the conflicts of interest without a scorecard. This story does seem to underline, in my humble opinion, the need to disclose all conflicts of interest, and the need to develop a structure for medical education (undergraduate, graduate, and continuing) that somehow avoids conflicts due to relationships with any organization, drug company, managed care organization, MECC, for-profit, not-for-profit, whatever that have vested interests other than discovering and disseminating the truth in a spirit of free enquiry (that is, the fundamental educational mission.)

We physicians also ought to remember the oaths we once swore, and stop trying to figure out clever deals to make more money on the side.

1 comment:

James M. La Rossa Jr. said...

I received this morning a release from Pri-Med West about its upcoming "Conference & Exhibition" at UCLA. Hosted prominently on the top of the ad is the Harvard logo.
See: http://view.ed4.net/v/2OJPSF/TBXPS/CVTTFE/N3Q37/

Coincidentally, just yesterday, I commented on the Carlat Blog that ... I couldn't help but notice that Dr. Samuels "decried most other MECCs, calling for the abolition of industry- sponsored satellite symposia at major medical meetings."

I believe that Pri-Med -- for which he directs the neurology CME -- has become one of the most successful independent medical meetings companies in numerous therapeutic areas.

As logic would have it, if one does away with satellite symposia at OTHER "major medical meetings," that leaves more $$ for sponsored CME programs at Pri-Med-hosted meetings.

By the way, from what I have seen, Pri-Med does a very credible job. But it's hard to deny that what we have here is another example of a single company that, 1. hosts the meeting, 2. works with industry-sponsors on presentation materials, and 3. accredits the CME. And you can't lay the blame solely at the feet of the pharmaceutical industry for these patent conflicts. They have no other choice but to go along with this. (In fact, if anyone out there wants to market a neurology drug, it sounds like Dr. Samuels is an important guy to get to know.)

As formerly noted on this blog, ONE COMPANY CANNOT WORK FOR THE SPONSOR, VET THE PROGRAM, AND ACCREDIT THE CME WITHOUT A REAL AND PRESENT PERCEPTION OF MEDICAL BIAS. It's really that simple.

I hope that the "conflict of interest" accusation hoisted upon Ms. Bastow of UpToDate (a company I had not heard of before), does not negatively influence the Macy Foundation recommendations. They may very well be the best opportunity at hand to help temper the groundswell of opinion that implies that medicine is for sale.

James M. La Rossa Jr.
Publisher & Editorial Director
MedWorks Media Global
Los Angeles, CA