An article critical of the University of Wisconsin’s Continuing Medical Education (CME) Department was published in the Milwaukee Journal Sentinel.
Company-funded University of Wisconsin courses often favor medicine, leave out side effects
The article is the typical hatch job by reporters and editors on physicians and medical educators against commercial support of CME:
A) Solicit critics of industry support of CME;
B) Ignore the facts; and
C) Find scientists and physicians that disagree with the premise of the course (there is always more than one side to any issue, even in science).
The paper notes that only four of the nine online courses offered by the University of Wisconsin have commercial support and that those courses that do not have commercial support charge $20.00 for CME credit. The non-commercially supported courses are focused around nutritional management of various metabolic disorders, including lipids, diabetes, hypertension, obesity, and metabolic syndrome.
The paper is critical of the University’s commercially supported CME programs and all commercial support in general quoting Arnold Relman, M.D. who has been retired since the early 90’s and has made a side living of doing exactly that – being critical of commercial support of CME and Daniel Carlat, M.D. who runs a paid subscription CME company and is using his blog to hopefully wipe out the commercially supported competition.
Some of the arguments against commercial support of CME include:
“It’s unethical and it is not in the public interest, because it is going to bias doctors to prescribe certain drugs.” (Relman)
“The drug companies have a captive audience,” (Carlat) and “drug companies have essentially hijacked the highest level of medical education we have in this country.”
Of course, the newspaper ignores many of the proponents of commercially supported CME, and it is clear from the paper that the writers have an agenda and are sticking to it.
George Mejicano, M.D., the Director of U of W’s Office of Continuing Professional Development provides some counter arguments:
“All CME courses at U of W are evidence-based, free of commercial bias, and are designed to help physicians provide optimal state of the art care for patients.”
The article reports that U of W officials in January appointed a panel to investigate the University's doctor education office. The action was taken after The Journal Sentinel exposed conflicts of interest and raised other questions about the University course on hormone therapy. The probe is part of a wide-ranging plan under consideration at U of W to change the way its doctors interact with drug companies.
The article reviews three University of Wisconsin projects that they consider prime examples of commercial bias. But as is the case of many newspaper articles, why bother with the facts when fiction is so much easier to write.
The first project is the large smoking cessation project that Pfizer funded through a coalition of 9 institutions in which University of Wisconsin receives $3.5 million of the $12.3 million total.
The story says that the research underlying the medication varenicline (Chantix) for smoking cessation excluded groups of people and thus is unreliable. The reporters mentioned one study that they claimed was too limited and implied that Pfizer's funding of the course was the reason Chantix was described as 'first-line therapy.'
It is not the U of W or Pfizer that says varenicline should be first-line therapy; it is the U.S. Public Health Service Clinical Practice Guidelines, created by a panel which spent years reviewing the strength of evidence on a range of smoking-cessation approaches and medications (including a review of more than 8,700 research articles).
Of the 24 members on the clinical practice guideline update, only three had financial conflicts — and all three of them recused themselves from voting on the guideline's pharmaceutical recommendation.
The stated point of the story is that drug company funding influenced the content of CME courses. But the writers ignored that the nation's leading experts, without such funding, agree that varenicline is the most effective known agent to help people who want to quit. Readers should have been informed that the leading national review group reached the same conclusion that the CME course offered.
The second course is a smaller course on restless leg syndrome supported by Boehringer Ingelheim which paid $321,000 of which the University received $17,000.
The course states the prevalence is unknown and some experts say that about 10% of adults have the disorder.
The newspaper stated that this was inaccurate and quoted an Archives of Internal Medicine paper in which the incidence in that study was closer to 2.7%. They also quoted a PLOS medicine article that challenged the statistics of the Archives research as being too liberal in its interpretation.
The problem with the papers interpretation is that prevalence estimates of many diseases vary.
The University sent to the paper three separate citations — all of them indicating that the 10 percent figure was, if anything, too conservative. One study cited a likely prevalence rate of more than 24 percent, with two-thirds reporting moderate to severe symptoms.
Apparently, the reporter ignored this specific information and left it out of the story when it was there for the reporters to see.
The third course that the paper outlined was an online course on premenstrual dysphoric disorder (PMDD). Supported by Pfizer and then Bayer, of which the University received $24,000 out of a $340,000 grant they shared with the non-profit Madison Institute.
The article quoted: The course cited a small study of Xanax, but failed to point out that only 37% of women who took it had significant improvement, compared with 30% who received a placebo. The course also did not mention Xanax' side effects, including the potential of dependency.
An internal U of W review last June, said the course could be viewed as "significantly commercially biased" in favor of treating the disorder with drugs. Little was done to address that concern in the final version.
The reporters wrote that “Little was done to address” the concerns about bias in the PMDD online course when, in fact, the U of W reviewer (Dr. Hugh Johnston) was the one who brought up the potential for bias and who signed off on the course.
The actual account of the reviewers which was provided to the paper prior to publication gave a completely different story:
Dr. Johnston had not received any pharmaceutical company funds.
Here are excerpts from the review process from the U of W reviewer: (June 11, 2008): “I reviewed this course and came away impressed with its clarity, its organization and its thoroughness. That said, it will strike some participants as being significantly commercially biased in favor of treating PMDD with medications rather than cognitive behavioral therapy (CBT). Whether the appearance is just appearance or reflects an actual bias is arguable – it is genuinely hard to tell.” These judgments were followed by (June 25, 2008): “With these revisions, everything looks fine from a content perspective.”
Overall the article ignored the facts and went out of its way to make something out of “well, nothing.”
Bias is one of those things in the eyes of the beholder (the “I know it when I see it standard” that Supreme Court Justice Potter Stuart used against obscenity).
If we were to apply this standard to all CME (which ignores that reviews were done and corrections made), we would not have CME, either paid for by Government or industry it does not matter.
CME is education, and education requires making definitive statements, otherwise it is just educational mush.
Milwaukee
Journal Sentinel
Article: Company-funded U of W courses often favor medicine, leave out side effects
Editorial: Rein In Pharma Money
Article: U of W course for doctors pushed risky therapy
Graphic Time Line: Chart Hormone Therapy Research and U of W
