Friday, September 19, 2008

The war on industry supported CME

---is heating up. It’s rather odd that Dr. Daniel Carlat, just yesterday, bemoaned the fact that “We’ve descended to the level of name-calling now” when he was doing some name-calling weeks ago (see this post and its references to dinosaurs and cornered animals).

What’s Dr. Carlat worked up about? He’s taking aim at the Center for Medicine in the public Interest (which he calls a reactionary unthink tank) for their upcoming seminar “Industry Support for Continuing Education of Healthcare Professionals: An evidence-Based Evaluation.” And what, pray tell, is wrong with making an appeal to evidence in this debate? It’s about time somebody did. All the agitators have to offer are personal attacks (did you know that if you favor industry supported CME you’re a dinosaur?) and ad hominem arguments about people’s commercial affiliations (true to form, for the symposium in question Dr. Carlat provides the usual litany). OK, Dr. Carlat, they’re biased. Just like you and me. We get that. But I’m concerned that you’re shedding more heat than light on this debate. Why not attack the arguments instead of the people?

Well, today Drugwonks, the CMPI blog, responded in kind. Go and read the whole exchange. It’s rich. This will be great fun to watch for a while, but eventually I’d like to see a sober evaluation of the question based on evidence along with a little respect for the law of unintended consequences.


Anonymous said...

Sadly, our efforts to try and reduce industry influence in CME and medical information feels like we're going backwards. We now have medical bloggers organizing and being funded by J&J, and joining up with a group of so-called science bloggers who are paid by a media marketing company. No one seems able to differentiate medical information from these companies from marketing and to recognize the bias. Medical professionals can't even see the conflicts of interest anymore, as it seems natural to them to shill for industry, regardless of the venue. I'm not sure what the answer is if so few even see a problem.

Anonymous said...

There is an irreconcilable conflict of interest between those who make drugs and those who prescribe drugs. Whether you find particular evidence to the severity of consequences of this conflict does not change the fact that it exists.

Big Pharma is in business to make money. Their multi-billion dollar for-profit model means that from their perspective, using their vast resources to game the system is rational and acceptable. They're not interested in increased patient outcome. They're interested in, at base, making it unprovable that any decreased patient outcome is attributable to their product. Deniability.

That people in the medical field are not qualified to understand this type of conflict is hardly a surprise. It is fundamentally an argument of economics, not medicine. The fact of the matter is that Merck (for the sake of argument) stands to make more money by providing mediocre drugs which are borderline unsafe, provided that they don't get in trouble for it, than they would make by providing excellent drugs which are positively safe.

"Getting in trouble for it" is a question of gamesmanship with federal regulators, and not so much with anything published in JAMA that might make them look bad. From their perspective, medical researchers are the easiest people to fool, and congressmen are the easiest people to buy.

That Big Pharma might be a mixed bag of good and evil is beside the point, and whether they're putting on a good show with respect to CME alone is beside the point. In the end game, any association with them at all is bad, because their behavior is primarily parasitic, and not symbiotic.

Anonymous said...

By the way, in economics, we call the particular way they game the system "rent seeking". Look it up.

R. W. Donnell said...

I believe Pharma has a business interest in good patient outcomes.