Friday, August 8, 2008

Meducation: Could CME exist without Big Pharma?

Recently, I had to get some continuing education hours to meet my CEUs (continuing education requirements) for psychologist license renewal. I have a “membership” with Medscape, an organization that reports medical news, features, content, and provides continuing medical education (CME) content for physicians. Since the content areas of psychology and psychiatry overlap, and since free CEU are better than dollar CEUs, I thought I would check out Medscape’s “free” CME offerings in the area of psychiatry.

So, I log in to Medscape. I click on the CME button. I click on the choice for “Psychiatry.” I select the option for CME articles published in the recent 12 months.

After a moment, a long list pops up.

I start to browse for a couple topics to round out my CEU hours.

I notice a pattern. See if you notice a pattern to the curricula offerings:

“Effectiveness of Second Generation Antipsychotics: A Systematic Review of Randomized Trials.”

“New Data in the Recognition and Management of Bipolar Disorder.”

“Augmentation Strategies in Treatment-Resistant Depression.”

“Improving Remission in Depression: Focus on Augmentation Strategies.”

“Improving Mental Health Outcomes: Focus on Atypical Antipsychotics.”

“Optimizing Management of Bipolar Disorder in Children.”

Patterns of Pharmacotherapy and Treatment Response in Elderly Adults with Bipolar Disorder.”

“Improving Remission in the Treatment of Major Depressive Disorder: Assessing the Augmentation of Traditional Antidepressants with Atypical Antipsychotics.”

“Pediatric ADHD: Guidelines for Initiating and Monitoring Treatment.”



In all, across approximately 125 CME course in psychiatry posted to Medscape in the past year, it really looks like the “atypical antipsychotics are good for everything” message is coming through loud and clear in about 75% of the articles offered.

From reading on this topic lately, I knew that Big Pharma was really pushing atypical antipsychotics, and their puppet spokesmen psychiatrists were promoting expansion of the borders of whom to diagnose and/or treat. But a peek into some of these articles shows a very consistent, coordinated campaign.

The term “obvious” comes to mind when thinking of Chik Fila’s EAT MOR CHIKN campaign. The Big Pharma campaign to get everyone diagnosed and hooked up to the antipsychotics is a bit more subtle, but equally consistent, sustained, and coordinated. Multi-pronged: radio, billboard, television, print, etc.


What if the obesity CME was sponsored by Chik Fil A, and breaded, fried chicken sandwiches were recommended as the nucleus of recommended diet for just about every diet-related condition? Wouldn’t we begin to wonder if we were being “sold” a bit strongly? What if your physician was recommending fried chicken sandwiches as a remedy for your obesity, or cholesterol, or hypertension, as he or she wrote out a prescription, with a Chik Fil A pen, for you to eat one Chik Fil A sandwich per day?


This brought home the issue that some other psych med bloggers have been noting: Big Pharma uses Key Thought Leaders (Big Pharma-sponsored psychiatrists) and Continuing Medical Education as marketing tools.

Because of FDA rules, Big Pharma cannot even hint that a med ought to be prescribed for some application, such as depression augmentation, unless the med has been FDA-approved for that application. However, Big Pharma can: 1. sponsor a particular physician’s research and 2. sponsor continuing medical education.

Did you catch that? That is how Big Pharma sponsors off-label use of their products while not violating, but side-stepping, federal law. Well, this is no revelation. Many people have noted this.

It just struck me as I went to get my CEUs. I just was struck by the extent to which Big Pharma has grown to control CME as I hunted for a couple free CEU hours for myself. Well, I guess it is true that you get what you pay for. I clicked away from Medscape and went and found some psychologist-intended CEUs.

There are, currently, many related controversies and emerging issues regarding the role of Big Pharma and COI. One debate is framed this way: Can the continuing medical education system survive without Big Pharma sponsorship?


Folks, here is the source. Of the money made by providing CME, over half is from Big Pharma providers. If you analyze the situation in different ways to get at the portion of CME “sponsored” by Big Pharma, you realize that closer to 90% of CME is supported by Big Pharma, an entity with a clear stake in the game.

The extent, and the tradition of the Big Pharma-sponsored lunch, is so entrenched in the medical system that some people actually wonder if we could still hold the requirement that practicing physicians ought to continue to receive education following licensure.

So, debate is everywhere. However, from my point of view as a licensed psychologist, and from the point of view of all of the other clinical professions where CME (or CEU or whatever it might be called) is required, we just cannot figure out what the issue is.

We all pay for CME that is, generally, free of Big Pharma, and, generally, we all make less than medical doctors. We don’t see any problem whatsoever. Do we like it? Well, generally, people are hesitant to part with their money. Do we manage? Yes.

Of course, you won’t get lunch with your CME.

But seriously: name a profession, outside of “licensed physician,” where the salary levels are so consistently upper middle class that anyone would even think to say that they could not AFFORD CME unless it was provided for free. Who?

Name professions where we DO pay for CME (and lunch is generally not provided). Psychologists. Licensed clinical social workers. Licensed marriage and family counselors. Licensed chemical dependency counselors. Licensed professional counselors. Licensed physical therapists. Licensed occupational therapists. Licensed massage therapist. Licensed Speech/Language Pathologist.

Doc, all of us can manage to scrape up the dollars required for a few CME credits per year. I think that question is now answered.

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