May I go on record as saying that it’s DEEPLY DISAPPOINTING to discover that a product you worked on in good faith turns out to cause more problems than it solves?
I’ve written on a variety of medical products, from a variety of perspectives — promotional, CME, brand strategy, medication adherence, publications… And really, each time I’m hoping that the right medications will get to the patients who can best benefit from them. Well, almost each time. I keep thinking that Restasis is something you could have a trained pharmacist mix up for you cheaply out of spare, generic cyclosporine [since that’s what the stuff is, just in particular, patented solution], and I don’t know what to think about Natrecor or Zyprexa these days.
But I can’t do my work properly if all the data isn’t made available. The good studies, the bad studies, the replications [Hello? Anybody still do those?], and the tremendously challenging ones where “excess death” in the treatment arm require immediate protocol changes.
Similarly, health professionals can’t do their jobs properly if they don’t get all the data, or if they’re distracted from it by the name/gravitas of an anointed expert [because we aren’t supposed to say “thought leader” or — God forbid — Key Opinion Leader]. Nor can they do their job of objectively counseling patients if advertisers are coaching these patients in the waiting room to “ask your doctor about….”
CME is part of the morass of conflicted interests, even though there are continual efforts to break the ROI thinking that makes CME an attractive thing for pharma/medical device companies to fund.
[The following text may also show up in a slightly different form as a comment on the Carlat Psychiatry Blog] It seems to me that CME ought to provide clear reviews of current medical topics, and probably should have to show up front what their search/inclusion/exclusion strategies were in producing such reviews.
It’s also clear to me that doctors don’t always have time or sufficient interest in adult education to produce such materials on a routine basis. Some can’t write their ways out of paper bags, and honestly, if they know their medicine and treat their patients well, I don’t fault them for that. There are people trained to use words in the service of medicine and science, and they should have jobs, too! Somewhere along the line we discovered it was better if there were professional statisticians and office support staff; I don’t think hiring a qualified writer is significantly different.
Except, of course, it hasn’t exactly been the physicians/health professionals who have been going out and hiring the qualified writers, has it? That’s a big part of the problem. Health professionals have been insulated from the genuine costs of getting their ideas into print and other media. That’s inappropriate. [And would health professionals be more prompt/hands-on if they did know how much it cost each time a draft was late back from review or a new reference was added at the last moment? I don’t know. But in health economics the idea seems to be that we shouldn’t insulate seniors from the costs of their own medical care, so why are we mollycoddling anybody else in the process?]
The next question is: how should these efforts be funded, and who should have oversight? Because really, the current model isn’t working. I know good people who try to hold every line the ACCME has drawn in the sand, and we still get things like Pfizer buying the credibility of the University of Wisconsin Medical School in order to promote [call a spade a spade, please] Chantix [Yes, I do understand that if Chantix is the only member of its drug class, or the only one of its kind approved for a particular kind of smoking cessation that including comparable alternatives in the CME is difficult. But forgetting to discuss side effects?!]
What do we do instead? If every licensed health professional had to pay a CME fee [along the lines of the tv license fee in the UK which funds the BBC], would that result in a fund large enough to fund authorized CME materials? Then the battle ground would be in the middle of the license-granting organizations, but at least the funding structure would be based firmly within the organizations supposedly in charge of assuring quality care.
So, there could still be agencies, but they would have to bid to get the work/funding, and the funding might well be below the level of what pharma has been supplying for the last few decades. That might drive out some of the companies, and the resulting materials might not be as glossy as those produced with pharma dollars, but the educational work could still get done. [I certainly would be willing to do it!]
I’m sure readers can ferret out the unintended consequences of such a system. Nothing on earth is incorruptible. And I know that a literature review can only be as good and as comprehensive as the data that actually reaches publication! But wouldn’t it be nice to have a reward structure that makes the discipline of medicine “the client”, rather than the maker of any one product?
What do you think? What would increase the odds of accurate information getting to busy people in a way they could actually use it to improve medical practice? [And yes, as an educator I am fully aware that even if we DID manage to put the best possible information in front of people’s eyes, they might misinterpret it, ignore it, or be swayed by other blandishments anyhow. But couldn’t we try giving it our best anyway?]