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Archive for March, 2009

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?

Thanks.

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.bangheadhere

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!]

farmrainbow3-09

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?]

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brickline-grassMost of my Spring Break has been haunted by student papers.  Or rather, the commenting and grading of student papers. I like to give constructive comments, but I also need to give clear indications of how far they’ve gotten towards adequacy at this point [and at this point, for most of them there is a very long way to go!].

The problem with coaching outside the sporting world is that the transition to accountability/assessment is much more arbitrary — in NCAA basketball, a coach does what he or she can to get the team ready, but the real TEST isn’t administered by the coach; it’s administered by the next game, meted out by the opposing players. The scoreboard, referees, and stadium crowds give feedback that go far beyond what a coach could ever say.

When I grade students, I’ve shifted gears from coach to judge, and some students never really grok that I am playing two very different roles simultaneously; they just think faculty are fickle….since along comes the next assignment, and suddenly I’m coaching again, until the next judgement day.

leiacloseredeyeThe irony is that I myself am in the assessment spotlight, but without benefit of coaching.  Leia may be adorable, but she can’t help me with tenure.

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Happy Nowruz, Happy Spring, Happy Oestra!

EclecticOilKittyNow would someone pass the mead over this way?

In writing about any topic it is essential to have the ability to recognize the differences among audiences and strategize the writing to meet those differences.

Initially, looking at the [item] one notices the journal is long in length.

The general public is always an extensive informative article.

Many flies were young.

The language that the author uses is also intense and hard to maneuver if you were a general audience.

And people wonder why I procrastinate with the grading….  Oy.

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beecrocusI know there are several hours to go until Spring is officially here, but the crocuses were blooming in the sun yesterday, and sure enough, there were bees.  Let’s give the lady here a big welcome, and hope her hive thrives this year!

Buzz buzz buzz, yes she does…

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People who need people

Lady RhetoricaIt’s difficult to explain to some of my students the importance of having trustworthy people to disagree with in your life.  They struggle with literature review assignments because they prefer to have everything “fit together” rather than consider conflicting data, or they decide instead that one bit of conflicting data should outweigh all the other reasoned approaches.  I have to remind them that reasonable people can have different opinions, and that probably that’s a survival advantage.

And yes, there are daffodils and crocus and the forsythia is getting started in the garden. I’ll get back to the pretty pictures stuff after I get more grading done.

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snowflake400

Do you want us to show specific studies that back up our information, or is that too narrow? Thanks

Um, short answer, “yes”, but I’m not exactly sure you know what you’re talking about.  How about delineating what this information you have is, and then I can let you know what the next steps might be?

We’ve only been working on the literature review project for the last three weeks….

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Now, by this point in life I have spent more of my life outside the state where I grew up than I spent growing up in it… but apparently the view of it across a river really does tug at my heart.  Why else would I be tearful driving down Columbus Boulevard trying to find a gas station before heading south?

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