Furious Seasons

June 14, 2007

Conflict Of Interest And CMEs

The New York Times had a fine op-ed yesterday (thanks to Anders for passing it along) about the massive conflicts of interest inherent in pharma companies sponsoring continuing medical education courses (CMEs as they are known) in the world of medicine. The op-ed is by Daniel Carlot, who authors the fine Carlat Psychiatry Report. You don't need me to summarize his words, so just go read it with the following context: In order to keep their state and board certifications, docs have to do a certain amount a CME units each year. These CME courses are often sponsored by companies, allegedly to offer doctors unbiased information about how to treat a particular disorder. Trouble is the courses are often not unbiased and lean heavily to supporting said sponsor's view of the disorder and how it should be treated. That's a problem.

For those of you have been through the Zyprexa documents, you'll remember that Lilly was lining up some very big names in the psych world to go out and teach CMEs concerning maintenance treatment of bipolar disorder using Zyprexa well in advance of that drug's FDA approval for that indication in 2004. I wonder how the researchers who taught those courses feel now that the drug has turned into a disaster for patients.

CL Psych has been banging on this issue over at his blog for sometime now, and it's good to see this matter getting the broader attention it deserves.

Anyhow, Carlat has a solution:

"The solution could hardly be simpler: any continuing medical education that is paid for by the drug industry should not be accredited. Drug companies could still pay for any educational event, article or pamphlet they choose, but their courses and materials would no longer bear the imprimatur and implied credibility of accreditation."

I heartily agree. While, we're at it, did anyone catch that Lilly sponsored a survey that found many psych docs reporting that their patients went of Zyprexa after seeing ads for plaintiff's attorneys on TV? In essence, Lilly is arguing that ads scare patients off meds. I actually know of one case where this happens to have occurred here in Seattle. I don't particularly care for DTC ads by lawyers. I utterly hate DTC ads for pharma products, especially psych meds. I think both sets of ads should be banned. Period.

And that's coming from one of the biggest free speech supporters you'll ever meet.

Posted by Philip Dawdy at June 14, 2007 12:03 AM

del.icio.us Digg it reddit

Comments

I appreciate Dr. Carlat's work, but I find it more than a little ironic that in an article banging the pharmas for their obvious conflict of interest in sponsoring CMEs, that no mention is made whatsoever that Dr. Carlat is also in the CME business and makes money from offering CME credit. Therefore his argument, while still valid, is also tainted by his own self-interests. If he wasn't competing against the pharmaceutical industry for offering these credits, he'd have a lot more customers and, subsequently, a lot more revenues.

Dr. Carlat is someone I have great respect for. I'm not sure why he shouldn't be held to the same standards he is holding others to, that is, full disclosure of conflicts of interest -- something clearly not done in the NYT op-ed piece.

Posted by: Anonymous at June 14, 2007 05:36 PM

To Anonymous . I don't understand your point about self interests.
Pharma Co. is trying to make money selling a medicine without questioning the scientific validity of the drug. This is wrong because A)it is not science, its like a con game and B)People/human beings will probably be harmed(if not die) from consuming a drug without knowing all the dangers associated with it.

Dr. Carlat carlat reportis trying to find science in psychiatric drugs and hurting who?

Posted by: Mark (p.s.2) at June 14, 2007 09:26 PM

I suggested a simpler solution: Docs should pay for CME. Please read my blog post "Welcome to the CME Laundromat!" for more on that!

John Mack

Posted by: John Mackl at June 15, 2007 05:07 AM

I remember in the summer of 2005 the esteemed Dr. Donald Milliken said he had just come back from a conference and was "all pumped up" and thus wanted me to try a new drug (in addition to the four I was already taking). I have my medical records so I could pinpoint the date. Could a Freedom of Information request tell me if the conference was sponsored by the maker of the very drug that he was trying to coerce me into taking? I'll bet my first born that it was.

Posted by: Francesca Allan at June 15, 2007 10:18 AM

Carlat's solution won't work.

Look, I know that it seems obvious that Pharma sponsorship leads to bias, and it does. But that's not the problem with psychiatry. The problem with psychiatry is that there is Pharma bias, and nothing else.

Doctors simply do not take responsibility for their own education. They do not read journals, they do not study, they are not critical.

If you take away Pharma sponsorship of CMEs, if you take away the paid speaker junkets-- if you take away the reps-- then the result will be doctors will not learn anything new. Ever.

You think your psychiatrists learned how to use Zyprexa from a rigorous reading of the journals?

And if you think I am exaggerating, ask you psychiatrist to name the titles-- not what they said, just the title-- of any article in the current issue of the Journal.

Posted by: TheLastPsychiatrist at June 15, 2007 06:03 PM

I have personally brought in articles from journals and print outs of abstracts to educate my daughter's psychiatrists. This is also the concern all should have with the psych meds for dogs issue. No veterinarian is going to learn on their own about Doggie Prozac or Cerenia Car sick pills--they are going to be "trained" by Pharma reps to medicate pets with psych meds.

Same goes for psychiatrists.

Posted by: Stephany at June 17, 2007 01:19 PM