Continuing Medical Education: Wisconsin CME Program Attacked Without Facts

The Milwaukee Journal Sentinel is at it again attacking the CME program at the University of Wisconsin with stories based on innuendo.

The story starts out with media coverage which has been portrayed to “millions of middle-aged men that their diminished sex life and somber mood may be the result of low levels of testosterone,” according to The Milwaukee Journal Sentinel.

The paper went on to link TV commercials to a CME program supported by Solvay, the maker of Androgel, a testosterone replacement manufacturer. It is unclear that there is any relation whatsoever to those two campaigns – one is currently running in 2009 (the TV commercials) and the CME programs were held in 2005-2006.

The series of CME activities which were a little over $1 million, of which the University received $115,000 for accreditation and administration, included a variety of activities from journal supplements to a series of local dinner meetings, at the end of the day, the University did a lot of work for not much money if you count all the administration that goes into pulling off such activities.

According to the paper, the controversy began when the University of Wisconsin accredited a series of CME journal supplements and dinner meetings by Dowden Health Media and accredited by the University of Wisconsin School of Medicine and Public Health, “read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.”   It is interesting that the reporter who would have no way of knowing if what he said about benefits and risks was actually true could make such a statement.

I asked a Ph.D. researcher to review a supplement from 2005, that was supported by Solvay and accredited by the University of Wisconsin.

Though he was not impressed with the scientific rigor of the supplement and suggested that more thought should have gone into issues like risk vs. benefit, clinical efficacy, poor referencing, higher risk of BPH, screening patients for prostate cancer, and worsening lipid profiles, and risk of infection for topical applications.

If the news article wanted to be accurate, it should have focused more on the actual product than trying to depict the program as advertising deception. Since 2005, the University of Wisconsin has instituted several layers of review to further ensure the medical accuracy and of their programs.

It is interesting that the reporter gives one the sense that there is significant patient harm that can come out of using testosterone replacement therapy for men with low testosterone counts. But the evidence is either neutral or opposite of what the reporter makes it out to be. In fairness to him, he did add some information at the end of the article. Today, doctors are not arguing that testosterone is like snake oil. Dozens of stories have produced promising results, though he fails to follow-up on those promising studies and focuses on a European study of 322 patients released in May which showed that testosterone (in this case oral testosterone) had  improvement but not reaching statistical significance, but a very significant benefit for patients above 60 years old and modest improvement in sexual function by patients using testosterone.

Another May Study showed that testosterone was 99% for male contraception.  The medical experts he interviewed also left out another European study of 200 patients on testosterone gel released in March that showed significant benefits for users.

Basically, there are a lot of studies that can go either way, depending on what one is studying and the jury is still out (though he does not mind convicting the University of Wisconsin on mixed evidence). He did mention that a larger 700 patient study is underway, which began in August to look at testosterone.

The article also makes a statement that the American Medical Association concluded that anti-aging claims for testosterone and other hormones were not supported by evidence and the drugs may pose long-term risks (though a search of both JAMA and AMA websites showed no recent articles on, or public statements since, January of 2008).

Then, the article makes the giant leap of linking testosterone to the Women’s Health Study conducted by the NIH which showed that HRT did not benefit, and in some cases, harmed women. The reason this is a giant leap is testosterone replacement therapy is exclusively for men with low testosterone levels and the Women’s Health Study specifically excluded men from the study – thus the Women’s Health Study.

Though the science is controversial on the use of testosterone (it is not without proponents on both sides of the issue) and since testosterone is a symptom drug (used to increase energy, lean muscle mass and libido in men) it would be doubtful that the 3 million + patients in American would continue to take it if there was no demonstrable benefit. My vote is for more muscle mass and more.

In the end it is pitiful that a reporter and vulgar bloggers can spend this much time attacking a CME provider dedicated to improving public health and only write stories on programs that at the time scientifically made sense, but since their publication may need to be updated.