Recently newsgroup user jkellymdmph asked a question that I had brought up when Google Co-op Health first launched:
How can this group health effort can resist infiltration by aggressive marketing?
jkellymdmph goes on to describe a continuing medical education (CME) event he attended that was supported with an unrestricted grant from a pharmaceutical company. There are two important notes in this story:
1) He thought the CME was very good, and “didn’t notice” that the supporter was a pharma company
2) … until the speaker began to tout the company’s drugs as “the best”
Obviously we weren’t there to see what happened, but this is not an unusual situation. There has been a debate long in the making over the state of continuing medical education and role of pharmaceutical industry support in the last few years. The accrediting body of CME – ACCME – has published guidelines aimed to minimize the harm that undisclosed conflicts of interest may bring to CME programs. ACCME was not intending on cutting CME events off at the knees by preventing industry from funding CME programs at all, although healthcare activist groups and America Medical Student Association may prefer industry to have absolutely nothing to do with CMEs.
I responded to the discussion thread regarding the question, “to whom do we turn for answers and who is paying for it?”
One way would be only looking at “the methodology and the data generated” on any study. If one were to only look at the method the authors used and see what data came out and disregard the discussion section (usually handwaving) then one makes one’s own conclusions about the validity of the data regardless of funding source.
The downside to this is that it can take a tremendous amount of effort and discipline on the part of the healthcare practitioner to keep updated on the relevant information. Additionally, physicians have a requirement to fulfill a certain number of CME credits in order to be in good standing to practice medicine, and my proposed solution only addresses the information credibility gap.
If the CME speaker touted the company’s drugs as “the best”, then concern may be either with the speaker or with the company. Since physician speakers are contractually bound to stay within guidelines that include fair-balanced representation of the data, using superlatives like “always” or “best” is bad judgment and dangerous in today’s compliance environment, not to mention corrosive to the speaker’s own credibility.
Since I’m not a physician and in fact, have worked in (and continue to consult for) the much reviled pharmaceutical industry, I’d be interested to hear what healthcare practitioners who need to keep up with CMEs think about this.
Dr. Mark Dayer is a UK-based cardiologist and responded thus (I added the bold/emphasis):
The problem is that making a really good assessment of the methodology and data is difficult. It is easier when you understand the area well and the mindset of the trial designers. I think dismissing the discussion as handwaving is going a bit far. For someone with detailed knowledge maybe, but for most it provides a bit of context and balance.
For me, as a cardiologist who is interested in heart failure, things are relatively easy. Hopefully a resource on heart failure would have solid links to the major guidelines – ESC, ACC/AHA, CCS, HFSA, NICE, as well as to articles by leading cardiologists commenting on the similarities and differences – for an example see an excellent article by John McMurray and Karl Swedberg in the August 2006 European Heart Journal. It would also have (free) access to the principle articles – such as EPHESUS and CHARM, underpinning the guidelines.
Payment is a problem – I would subscribe to a really good resource and be happy to look at adverts. I would have no problem with the companies putting links into their drugs to put their spin on things and to provide costing and pharmacological data. If they are presented in the correct context then I think bias would be minimised. There should probably be some charity and government money too.
Disclosure: I’ve been an employee in the pharmaceutical industry and currently provide medical affairs consulting services to biopharmaceutical companies. I also publish gratis columns for pharmaceutical sales reps on how to appropriately and ethically promote their products.