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35 posts from January 2009

January 29, 2009

Commercial Support of CME Receives Broad Support by Physicians

A study of 902 U.S. physicians, by healthcare market research firm, Manhattan Research, found that only 9% oppose commercial support for CME funding.  The results of this study are relevant to the ongoing discussions in the medical community about the role of commercial funding of CME.

In an effort to better understand the positions of those who actually use CME, Manhattan Research surveyed physicians on their opinions with regard to their use and the potential bias of industry-funded programs.  The Manhattan Research study reports that only 8% of physicians who participated in CME believe that it is biased.  In fact, if commercial support were halted, nearly one-half of the physicians surveyed would decrease their use of CME.

According to the study, almost all physicians utilize CME programs to maintain and grow their medical knowledge and to keep up-to-date on the latest advances in their specialty with the ultimate goal of improving patient care.

Pharmaceutical companies are a funding source for CME programs, which has prompted some critics to question their influence over CME course content.  In response, the Accreditation Council for Continuing Medical Education (ACCME), the organization that accredits CME providers, has augmented its standards and guidelines to ensure the independence of commercially supported CME activities.  The American Medical Association’s Council on Ethical and Judicial Affairs (CEJA) is also expected to issue a new report on commercially-supported CME later this year.

“While there’s been debate around the value of industry-supported CME, as our study reveals, it’s important to listen to the voice of the majority of physicians,” said Mark Bard, President of Manhattan Research.  “Rather than pulling the plug on a vital source of CME funding, the primary beneficiaries of CME - physicians and patients - would be best served by continued improvements to course availability, offerings, and content through increased collaboration among medical and academic organizations, the pharmaceutical industry, CME providers, and accreditation bodies.”

About the Study

Healthcare market research firm Manhattan Research conducted a survey to gauge physician opinion on commercially-funded CME and the proposed ban.   

The online survey was fielded in Q3 among a nationally representative sample of 904 U.S. physicians, including primary care and specialist audiences. Although we did not mandate strict demographic (age, region, practice setting) quotas reserved for very large global tracking studies, it naturally fell out very close to a national distribution on all those fronts.


They conduct numerous large physician studies on a global basis throughout the year using RDD (random digit dial) telephone recruiting, but for this study we actually pulled from a nationally representative sample using an ONLINE methodology. They increasingly use online for research in the U.S. given the online population of physicians mirrors the general physician population (99% are actively online in the U.S. today according to our RDD studies). For this study they recruited primary care and specialists from respondents within the online panel to ensure a mix of opinions. Although the physicians in the online panel are recruited from phone, fax, mail, and email they are in fact online given that they have to complete the actual survey instrument online.


The value of commercial support for certified CME of physicians is widely misunderstood by the media and policy makers.  Studies like this confirm the importance of commercial support of CME for physicians. 


Research:  Fact Sheet on Support for CME

January 26, 2009

Massachusetts Gift Rules: State of Unreality

"I don't buy that this [Massachusetts Gift Ban] will have any material effect on the convention business in Massachusetts," said Senator Mark C. Montigny.

In Monty Python’s Flying Circus, a battle ensues where the Black Knight continues to threaten King Arthur despite getting both his arms and one of his legs cut off:

Black Knight: Right, I'll do you for that!
King Arthur: You'll what?
Black Knight: Come here!
King Arthur: What are you gonna do, bleed on me?
Black Knight: I'm invincible!
King Arthur: ...You're a loony!

According to The Boston Globe, this is exactly how politicians and anti-industry activists in the Bay State are reacting to the current and potential loss of convention business for Massachusetts as a result of the passage of strict restrictions on medical meetings. 

These groups and politicians are making outrageous statements after two conventions (American Academy of Allergy, Asthma and Immunology and American Society for Gene Therapy) announced this week they were canceling their conventions to be held in Boston, and Heart Rhythm Society communicated in a letter to the Boston Convention Bureau that, as a result of the rules, they are considering canceling five conventions between 2009 and 2021.

One consumer group and a legislator who pushed for the law, called the concerns far-fetched.  Health Care for All, a Boston-based consumer advocacy group that is lobbying for even stricter regulation of industry interactions with physicians, said the medical groups are engaging in "fear-mongering" as a way to cast doubt on the new rules, which will be finalized within the next two months.

On the subject of industry, scientists are being banned from presenting posters and presentations, "That's absolutely false," said Amy Whitcomb Slemmer, Executive Director of Health Care for All.  "Of course company scientists can present.  But having providers get education credit for that is not appropriate.  It's an advertisement."  If you outlaw presentations that are not continuing medical educationally–accredited, then industry scientists cannot present, why else would the associations cancel their conventions?

"I don't buy that this will have any material effect on the convention business in Massachusetts," said Senator Mark C. Montigny, a New Bedford Democrat who has pushed for years to ban industry gift-giving.  "But even if it does, I would say it's completely irrelevant.  We're talking about rules to protect the public health here."  Translation -- I do not care about the economy of Boston.

The city hosted 2,500 medical and pharmaceutical company meetings in 2007 and 2008, attended by thousands of doctors and other clinicians; hotels earned $130 million from those meetings, while the state received approximately $16 million in tax payments, according to the Greater Boston Convention and Visitors Bureau.  Approximately 40 percent of the city's convention business is medical-related.

One day, the politicians and activists in Boston will realize that there are serious economic consequences for their blind hate of industry, but for now, they are living in a “State of Unreality.”

The Boston Globe:  New drug firm limits prompt fears of falloff in medical meetings in city.

January 23, 2009

New England Journal of Medicine: Online Disclosure

The New England Journal of Medicine has a perspective on reporting physician relationships to industry and they are advocating a system similar to the Duke Clinical Research Institute, disclosure forms.

They note several institutions and one state currently has online reporting available including:

Minnesota Gifts Registry (which also include payments to veterinarians)

Cleveland Clinic (find a doctor)

Psychiatric Times Editorial Board

Trustees of the North American Menopause Society

He notes that Massachusetts is going to have more detail. 

Overall he makes a case for disclosure, and falls into the trap of using the typical junk science arguments but seems to be more reasoned than past authors in the major journals.

The author Robert Steinbrook, MD (physician journalist at Dartmouth with no research in his bio) calls for a simpler and more efficient alternative that has been advocated by Robert Califf of Duke University would be to establish a searchable national database. The database might be administered by the National Library of Medicine or another federal agency, and it might be analogous to, the online registry of clinical trials, or, the database of the Center for Responsive Politics, which tracks money in U.S. politics.

What a coincidence that the article came out on the same day as the introduction of the Physician Payment Sunshine Act 2009.

Online reporting may help dispel the myth that doctors are unduly biased by industry.  Physicians involved in doing the work (research, consulting and speaking), need to wake up and speak out for themselves, it is easy for politicians to attack you if you are silent.

New England Journal of Medicine:  Online Disclosure of Physician-Industry Relationships


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