Sunday, June 15, 2008

MEDSCAPE'S CME ETHICS

17 June 2008

MEDSCAPE’S CME ETHICS

Like global warming, the erosion of professional values and medical education by commerce shows no sign of slowing. The latest scandals involve Medscape. Medscape is a medical communications company that produces and distributes CME programs and other quasi-educational offerings, such as “Expert Interviews” and News items. A subsidiary of WebMD, Medscape is accredited by ACCME, and it relies on drug company money for its production costs. Medscape also displays multiple advertisements on every web page. Medscape uses salaried and contract medical writers to produce the “educational material.” The content is pedestrian, mainly because it makes no pretense of really educating – it is primarily a vehicle for promoting the sponsors’ products with varying degrees of slyness and subtlety, as Daniel Carlat has documented here http://carlatpsychiatry.blogspot.com/2008/06/medscapes-cme-corruption.html#links Some items are academic wallpaper, non-promotional pieces designed to create an appearance of commitment to education. For most featured items, Key Opinion Leaders (KOLs) are hired to push the material. These KOLs are paid for their roles, although Medscape never says so, much less discloses how much it pays. If they wish to be engaged regularly, the KOLs know they need to stay “on message.” These are standard arrangements in today’s amoral world of CME. Daniel Carlat recently published a fine exposé of Medscape’s corruption of CME standards (link above).

An especially distasteful practice is Medscape’s use of the names, reputations, and credibility of major professional societies to give its indifferent CME offerings and infomercials more pizzaz. Just to give two examples, Medscape web pages are currently hijacking the public images of both the American Psychiatric Association (APA) and the American College of Neuropsychopharmacology (ACNP), featuring highlights of these organizations’ annual meetings as CME and other items. These “highlights” from the APA and ACNP meetings are offered by Medscape FOR CME CREDIT!!! For us to call this presumptuous would be an understatement. For Medscape to dress it up with sanctimonious statements about avoiding conflict of interest is insufferable.

Both APA and ACNP annual meetings are closed events, so how does a commercial CME outfit like Medscape get its hands on these restricted materials? The most likely explanation is that venal KOLs accept Medscape payments for producing puff pieces with the organizational tagline (highlights of the APA/ACNP meeting!). In effect, these KOLs trade on their membership in professional organizations for personal gain in return for “authoring” Medscape-produced CME items, “Expert Interviews” and News pieces. How tacky is that? The KOLs who “authored” mini-manuscripts or provided “Expert Interviews” for Medscape’s “highlights” of the 2007 ACNP annual meeting, whether as infomercials or wallpaper, should know better. You can find them here and in the associated links: http://www.medscape.com/viewprogram/8683

Medscape is paid by Pharma to produce these items. The APA 2008 annual meeting highlights on Medscape’s website were supported by an “independent educational grant” from Shire and by an “unrestricted educational grant” from Bristol-Myers Squibb Company/Otsuka America Pharmaceuticals, Inc. It is a good bet that Medscape shares none of that revenue with the APA. Likewise, the ACNP 2007 annual meeting “highlights” were supported by an “independent educational grant” from Vanda Pharmaceuticals. We can be sure ACNP saw none of that revenue.

So what we have is Medscape profiting from Pharma sponsors while juicing up their mediocre CME offerings with tag lines to “highlights” of the APA and ACNP annual meetings. How tacky can you get? How tacky? This tacky: Here is the disclaimer published by Medscape’s lawyers regarding the ACNP meeting.

Legal Disclaimer
The materials presented here do not reflect the views of Medscape or the companies providing unrestricted educational grants. These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. All readers or continuing education participants should verify all information and data before treating patients or employing any therapies described in this educational activity.
The materials presented here were prepared by independent authors under the editorial supervision of Medscape and do not represent a publication of the American College of Neuropsychopharmacology. These materials and the related activity are not sanctioned by the American College of Neuropsychopharmacology or the commercial supporter of the conference and do not constitute an official part of that conference.
Copyright © 2008 Medscape.


An additional disclaimer states, “This activity is not sanctioned by, nor a part of, the American College of Neuropsychopharmacology.” Well, fine. If it wasn’t sanctioned, why is Medscape splashing it over its web pages? I am confident ACNP gave Medscape no such authorization.

One hopes that APA and ACNP will publicly disown this corrupt use of their names and reputations for commerce by Medscape. The situation with APA is problematic because the incoming APA president, Alan Schatzberg, has been a frequent “Expert Interviewee” on Medscape. It remains to be seen whether his compromise and conflict will affect the organization’s response.

So, nobody at Medscape is accountable for the bias and bs in these items, even though they were written by Medscape staff and contractors. Medscape’s disclaimer tells us to go after the “independent authors.” That’s exactly what I intend to do in my next posting. Meanwhile, if Medscape wants credibility it will need to clean up its act. A good place to start would be to stop using these compromised KOLs who push infomercials and who provide soothing wallpaper. The real solution would be for Medscape to stop its skimming and money laundering activities altogether. Perhaps that is hoping for too much. Or they could just run naked advertising and they won’t need to bother with ACCME requirements. On the other hand, self-respecting health care professionals can just say no to Medscape’s kind of crap.

And what exactly does an “independent educational grant” mean, anyway? We will examine that trope in my next posting, which features the poster boy for compromised KOLs in psychiatry, Charles Nemeroff, MD from Emory University’s department of psychiatry. In that example, Medscape joins forces with Nemeroff to promote an entirely new level of sleaze. Stay tuned.

4 comments:

Michael S. Altus, PhD, ELS said...

“What does all this mean for Medscape and eMedicine, the largest single source of CE for health professionals? We are just going to keep doing what we are doing. It is good. We are clean. Our work is transparent,” insists George D. Lundberg, MD, Editor-in-Chief of The Medscape Journal, Medscape Core, and eMedicine.
“Responding to the American Siege Against Continuing Medical Education”, posted 06/12/2008, Available at _http://journal.medscape.com/viewarticle/575699_.

Disclosure: I am a freelance medical writer-editor who writes CME that is sponsored by pharmaceutical companies.

Bernard Carroll said...

Thank you for your comment, Dr. Altus. I watched the video of George Lundberg, MD defending Medscape and was in disbelief. The term dinosaur came to mind. Then I saw Daniel Carlat's posting today -- he had the same reaction, and he used the same term. I recommend all readers look at this video http://journal.medscape.com/viewarticle/575699 and judge for themselves.

James M. La Rossa Jr. said...

I would like to thank Dr. Carroll for his fascinating follow-up on DC's post about Medscape. Although I would like to offer one important clarification by way of the First Amendment. Your comment that "Both [the] APA and ACNP annual meetings are closed events, so how does a commercial CME outfit like Medscape get its hands on these restricted materials," is not entirely accurate. The APA invites each year credentialed press to cover its meeting. Once you invite the press, you cannot restrict its coverage.

Dr. Carroll is accurate about the ACNP convocation; it is an officially closed meeting. When I have attended the ACNP, I made the commitment to NOT cover the meeting as a journalist, which I have always honored. Perhaps the ACNP did not make the same request of Medscape.

Anonymous said...

I was trying to understand the recent cited editorial in Medscape about an "assault" on CME and thought the title and the post reactions as too emotional, less reasoned, almost canned, scripted and overely defensive. It reminded me of the lady who protested too much.

The assault if there is one is against corrupting influences on everything starting with the word "medicine", whatever the perceived sources, including drug and medical device companies.

Those corrupting influences express themselves as potential and actual conflicts-of-interest among a relatively few medical doctors, but the accusations, as well as being known by the company you keep is destroying public and patient trust.

We have often reacted to different stories and editorials at Medscape trying to connect these points and also to tie them into the as important issues of cost and quality, including potential and actual harm caused by medical care received (MCR).

Any one interested in receiving a documented presentation on these subjects made at the National Congress on the Un and Underinsured (Washington, D.D., December 2007) may do so by e-mail with Presentation in the Subject line and your name, affiliation, e-mail and phone number in the text section.

We are not connected to any party, person or entity, have no financail disclosures and seek to advance discussion on substantila solutions to our ill MCR.