Monday, September 15, 2008

Anthony DeMaria defends industry support of CME

Anthony DeMaria, MD is editor of the Journal of the American College of Cardiology (JACC). He’s also chief of Cardiology at UCSD. He probably has better things to do than read this blog. Yet, (if you’ll indulge me in a little self aggrandizement) his recent JACC editorial echoes the exact points I’ve made repeatedly in these pages. This may sound familiar:

Most will agree that the separation between the composition of educational programs and commercial interests has not always been perfect. Perhaps it shouldn't be. It seems to me unreasonable to think that a company that produces angioplasty catheters would be interested in sponsoring a program on obstetrics. As pointed out in a statement from the Council of Medical Specialty Societies, the Gerber Foundation, dedicated to advance the quality of life in infants and young children, would not likely be interested in supporting programs on Alzheimer's Disease.

And this:

…I worry that termination of all commercial support is a major overreaction. The goal that underlies eliminating commercial funding—that is, to insure program objectivity—can be accomplished by existing CME-granting agencies. Certainly medical societies and academic institutions should be capable of excluding inappropriate industry impact. In addition, is not clear how or if the financial support for CME provided by industry could be replaced. Without these funds, important opportunities to increase knowledge might be unavailable to busy clinicians, thereby denying their patients the benefits of this learning.

Dr. Daniel Carlat, author of the Carlat Psychiatry Blog, took this swipe at the last sentence:

By the way, cardiologists pull in an average of $270,000/year. But according to Dr. Demaria, they are still too poor to pay for their own education

It’s a misrepresentation of what he said, coming across as little more than a cheap shot. I don’t need to explain what Dr. DeMaria actually meant. The editorial goes on to cite an important consequence of eliminating industry support for CME:

It is not known what industry would do with the money they are currently directing to CME. However, it would likely go to more promotional events and/or direct-to-consumer advertising, neither of which addresses the concerns that have been raised. In fact, such alternate venues would probably only serve to further increase the use of products.

Except for the words likely and probably that’s exactly what I’ve said before. This unintended consequence is easy to spot but has been largely ignored.

He goes on:

I have a further, even more basic, reservation about the proposal to end commercial support for CME. Inherent in such an action is the idea that physicians are like sheep: easily led and without the ability to recognize biased or slanted information. I find this demeaning to the profession. In my experience, physicians are more skeptical than naïve; by nature they are not anxious to accept, but rather are waiting to be convinced. Given the competitive demands entailed in becoming a physician, we are likely intelligent enough to recognize bias when it is present.

Indeed. Physicians are mind numbed idiots. That’s the major premise underlying this inquisition. Proponents of that tired argument are armed with “studies”---soft survey and sales data on the effects of drug rep promotions which have nothing to do with CME or patient outcomes. I’ve previously addressed those arguments, and the evidence behind them is insufficient for the advocates of industry free CME to sustain their burden of proof.

Dr. Roy Poses of Health Care Renewal also weighed in. Both Poses and Carlat accused DeMaria of claiming that disclosure solves everything, then criticized his own failure to disclose. Either they didn’t read the editorial carefully or they erected a straw man so they could ridicule DeMaria’s lack of disclosure. DeMaria makes no assertion that disclosure is a “panacea” or that it resolves anything. Nothing of the sort. I read the editorial three times. It is clearly an opinion piece. It makes no claims. It makes no pretense of objectivity and advocates no policy changes. It merely raises questions and issues a plea that we “think long and hard” before making sweeping changes.


Anonymous said...

So your argument is basically that physicians should encourage the engagement of Big Pharma funds into CME, because otherwise Big Pharma would be doing worse things with it?

What kind of delusional logic is that? It sounds to me like Battered Wife Syndrome, where she rationalizes that when her husband is beating her, at least he's not beating the children.

R. W. Donnell said...

So your argument is basically that physicians should encourage the engagement of Big Pharma funds into CME, because otherwise Big Pharma would be doing worse things with it?

No. I made many argments. What you cited (distorted, actually, because I didn't say we should encourage Pharma funds)is my incidental reminder of the inevitable unintended consequences.