CME, Key Opinion Leaders, and Responsibility

Continuing medical education continues to get slammed (1, 2), and somehow the name of Charles Nemeroff keeps finding its way into these incidents. I wrote last week that Nemeroff co-authored a CME piece, on which he failed to disclose a conflict of interest regarding CeNeRx, for whom he co-chairs the scientific advisory board. The conflict of interest that was not disclosed was quite relevant, as the CME article was a cheer piece for MAOI's, and it just so happens that CeNeRx is in the MAOI business.

Daniel Carlat noted that another CME article upon which Nemeroff was an author has been criticized harshly; this one was dissed by one of its own authors. C. Lindsay DeVane, a coauthor, called it "a commercial piece of crap." Let me state this ever-so-clearly: An author called his own article a commercial piece of crap. This should send shivers up and down your spine -- if authors can't even trust the work upon which their name appears, how the hell are physicians supposed to trust it? Taking it a logical step further, how are patients supposed to trust their physicians if M.D.'s are receiving "education" that is "commercial crap."

I should mention that to Nemeroff's credit, on the "crap" article, he discloses an interest in CeNeRx.

What is authorship, anyway? Everyone knows that CME articles are quite often ghostwritten to reflect key marketing points. It's actually fairly comical that a lot (perhaps virtually all?) of the CME litter-ature is written by ghostwriters, and then key opinion leaders such as Nemeroff, DeVane, Keller, et al sign off on them. To be fair, it's not necessarily all that different from clinical trial literature, which is also frequently ghostwritten by industry-friendly writers (1, 2 ).

So we're left with a new definition of "author" on a scientific paper or CME piece:

Author: Someone who stamps his/her name on a paper to lend extra scientific credibility to the marketing of whatever product is discussed most positively in the manuscript. Having read the paper, written the paper, or having anything to do with the paper/study whatsoever is entirely optional.

Time: Some have said that the "authors" of these CME pieces are not to blame because those mean CME outfits send the proofs of the articles to be approved by the authors so quickly that the authors don't have time to review them. That is perhaps the WORST argument I've heard in a while. If that happens to an author once, I can understand...

Perhaps you're a well-meaning scientist who is hoping to provide something of value to educate your colleagues in a CME piece. Great. Then the ghostwriters throw together something that might be described as, um, "a piece of commercial crap," email you the manuscript to approve in 24 hours or else their version stands as the final version. At that point, you have hopefully learned your lesson. If you are repeatedly performing this exercise, lending your name to commercials passing for education, in which your own scientific views are not represented by the CME pieces, then you have nobody to blame but yourself.

Of course, there may be some whose views are accurately represented in CME pieces. Good for them. Have dozens of CME articles under your name, by all means. But, by God, let's not have any more statements like "the article with my name on it does not reflect my own views." I sincerely applaud Dr. DeVane for admitting that the CME article in CNS Spectrums is a joke. Now let's hope that he never finds himself in such a position again. Fool me once, shame on you; fool me twice... The worst forms of CME, which are marketing points covered with a very thin veneer of science, can only exist so long as "key opinion leaders" continue to sign their names on such pieces.

On a final note, I'd like to know if Nemeroff and Preskhorn, the other two authors on the CNS Spectrums piece likewise view the article as "crap" and if they would be willing to disavow themselves of the study. Here's betting they will have not a word to say on the topic.

Also read Pharmalot's great piece on the topic.