A little known provision in the House health care bill would require the $1 billion continuing medical education (CME) industry to disclose more about what it's teaching the nation's doctors:
WASHINGTON—Health legislation moving through Congress would force
drug makers to disclose how much they spend on continuing medical
education classes for doctors, sparking some resistance from the
For-profit continuing medical education companies have seen revenue
fall by double digits in the last year, according to industry
statistics, following congressional investigations into the influence
of drug makers on medical research and course content. [WSJ]
I used to write CME modules on high blood pressure drugs, sleeping pills, anti-malaria medicines, anti-depressants, hepatitis vaccines, and other remedies. Keep in mind that I quit medical writing several years ago and the
rules have changed a lot since I left.
Sometimes these CME modules were financed by drug companies. In which case, they'd often consist of PowerPoint slide decks summarizing industry-funded research, which had been presented by industry-funded experts at industry-funded conferences.
The drug companies would give
these training modules away. Doctors could answer multiple choice questions to earn points towards renewing their medical licenses. Sometimes CME companies would commission CME modules to sell to doctors for a profit. Some CME is produced by non-profit corporations and/or independent academic or professional outlets.
The drug companies did hire real doctors and lawyers to make sure that non-doctors like me didn't accidentally recommend anything lethal or fictional. This was called "med/legal review." Med/legal sent stuff back to us all the time when creative excess got the better of us and we started making claims that were "too promotional." This was a necessary check because we answered to marketing executives.
Review was thorough because the company didn't want to get sued. But a CME module that will stand up in court isn't automatically a quality teaching tool for your doctor. The standard for a true claim was basically whether the statement had been accurately paraphrased from an approved source, typically a peer-reviewed study. Usually, the drug company would tell us which papers to use. More often than not these were write-ups of research sponsored by the company.
It was obvious to me at the time that this was no way to go about educating the nation's doctors. It wasn't that the information was false, it was just profoundly biased in favor of whoever was selling the drug. The drugs with the most money got the most exposure. Doctors could learn about the latest blockbuster for free, but they'd have to pay out of pocket to learn about a less heavily marketed alternative. So, doctors being much busier versions of normal people, were more likely to learn about whatever the industry literally put in front of them.
The overriding goal was to familiarize doctors with the key sales points for that drug. The specific claims were backed up by research, but at the end of the day doctors were getting a heavily-footnoted sales pitch. The primary object of the exercise was to hype a product, not to disseminate scientific truth.
At a time when the future of health reform depends on cost control, it might not be such a good idea to let pitchmen educate doctors.
More transparency in the CME industry can only be a good thing. The public might not like what it sees.