Wednesday, January 23, 2008

Key Opinion Leaders, Continuing Medical Education, and Utter B.S.

Psychiatrist Bernard Carroll has another brilliant post on corrupt, er, continuing medical education (CME) and how the process has been co-opted by various commercial interests. His post a few days ago was certainly great, and in combination with his current post, I officially declare that Bernard Carroll is ON FIRE!

Here's a bit of what he had to say. Commit this paragraph to memory:
Medical journals are not the only compromised medium. Continuing Medical Education (CME) is a second front in the campaign to expand the AAP [atypical antipsychotic] drug market. The standard formula calls for corporate sponsorship channeled through an “unrestricted educational grant” to a medical education communications company (MECC). The MECC employs writers to prepare the “educational content,” and academic KOLs are recruited to deliver this content. The KOLs are chosen for their willingness to be “on message” for the corporate sponsor. If they go “off message” they know they will not be invited back. The talk of “unrestricted grants” is window dressing. The MECC also secures the imprimatur of a nationally accredited CME sponsor, typically an academic institution. The sponsor is paid to certify that the CME program meets the standards of the Accreditation Council on Continuing Medical Education (ACCME). Everybody turns a buck: the MECC and its staff are handsomely paid (CME is now a multi-billion dollar business); the KOLs are generously rewarded with honoraria and perquisites; the academic sponsor is well paid by the MECC; the ACCME receives dues from the academic sponsor; the audience obtains free CME credits rather than having to pay for these required educational experiences; and the corporate sponsor gets what it considers value for its marketing dollar.
Guess what... Charles Nemeroff is also featured -- regular readers will note that his name has appeared on a few occasions on my site. Carroll takes apart a recent CME exercise in which Nemeroff featured information that appears to be false. In fact, I detailed some of the problems with this CME exercise here. Carroll's post has a number of updates. Chances were given for this CME exercise to be redeemed in some form, but misinformation apparently prevailed yet again.

Regarding another of the atypical antipsychotics discussed in this wonderful CME piece, Carroll wrote (in part) the following:
When discussing aripiprazole for nonresponding depression, Dr. Nemeroff once again was economical with the truth. Note that Bristol-Myers Squibb, the marketer of aripiprazole, sponsored this PeerView/UCLA program. To document his claims about aripiprazole, Dr. Nemeroff cited one Abstract from the American Psychiatric Association meeting in May 2007. That does not meet ACCME standards of documentation for learners, most of whom would be unable to access the cited Abstract (not that it would tell them much even if they could). For some reason, Dr. Nemeroff did not inform learners that the complete report of the aripiprazole study had appeared in June 2007 (Berman RM et al. J Clin Psychiatry 2007;68: 843-853), fully 5 months before the CME event went on-line. From that readily available report it is clear that the Number Needed to Treat (NNT) for response with aripiprazole is 10, which compares unfavorably with a NNT of 4 for lithium, the best established augmenting option in placebo-controlled trials. A NNT of 10 means a clinician would need to treat 10 patients with aripiprazole before obtaining one remission that would not have occurred anyway with placebo. That does not constitute compelling clinical benefit. Dr. Nemeroff did not candidly discuss these troubling data. Dr Nemeroff provided his CME audience none of the remission or response data from the published aripiprazole study, though these data were readily available. These omissions of published, highly relevant information signify disrespect for his audience by Dr. Nemeroff, incompetence by the MECC, and failure of due diligence by the accrediting institution, UCLA, to ensure that accurate, balanced information and adequate documentation are provided.
I shall not steal any more of Carroll's thunder. Head over the Health Care Renewal and check it out in full.

1 comment:

Stephany said...

CP, great posts you've got going here