What if the written road test drivers take were sponsored by BP or Shell and had marketing messages interspersed? That has been the situation with Continuing Medical Education courses or CME, required for doctors to keep their state licenses and sometimes insurance. CME courses are supposed to be monitored by accreditors but, like Standard and Poor's and Moody's stock ratings, funding generally comes from the client side so the "fox is guarding the hen house."
Is your doctor .trained. by sales reps? by Martha Rosenberg
Until transparency laws came on board with the ACA, CME courses did not even hide drug company funding. For example, a 2008 course called "Bipolar disorder: individualizing treatment to improve patient outcomes, part 2" was taught by teachers who were funded by Abbott, Eli Lilly, AstraZeneca; GlaxoSmithKline, Janssen, Novartis, Pfizer, Wyeth, Bristol-Myers Squibb, Shire and four more drug companies.
When drug companies first began sponsoring CMEs, it seemed to solve two problems--paying for the courses (so doctors and providers did not have to pay) and providing a captive audience for drug sales pitches. But questions about bias and bad science emerged.
Bernard Carroll, a former chairman of psychiatry at Duke, challenged the objectivity of a CME Outfitters course called "Atypical antipsychotics in major depressive disorder: when current treatments are not enough," funded by Seroquel maker AstraZeneca. The course was taught by psychiatrist Charles Nemeroff whose unreported drug company income was investigated by Congress and who left Emory in disgrace.
Two doses of Seroquel were tested but only the results of one were "statistically significant," wrote Carroll on a blog called Health Care Renewal. "One of the junior presenters stated very clearly that there was 'significant improvement in both response and remission with both doses' of Seroquel. That is a falsification of the scientific record," wrote Carroll.
Similar methodology questions were raised about a Lancet CME called "Quadrivalent HPV vaccine may be effective in women 24 to 45 years old," written by two Merck employees and other authors. Why did the authors exclude women "with pre-existing infections and women who do not complete the full course of the vaccine," asked six researchers with the U.S.' National Cancer Institute in a follow-up letter. Why was "infection of 6 month duration or longer" used as an endpoint for showing a public health cancer benefit asked a different set of researchers? You call that "science"?
CMEs are especially useful to drug companies when safety questions are raised. When dentists, oral surgeons and patients began noting the side effect of osteonecrosis of the jaw (ONJ) with osteoporosis drugs (bisphosphonates) companies assembled CMEs that suggested to practitioners it was not the drugs but patients' poor "hygiene" that was causing the serious and disfiguring side effect. Right.
Seven years after hormone replacement therapy was linked to increased risks of cancer, heart disease and stroke and recommended to be used for as short a time as possible, Pfizer (which had absorbed hormone maker Wyeth) spent $2 million to fund CME courses on the...benefits of estrogen! The drug giant was sticking to its story. The "courses" were held at Duke University, Penn State University and University of Oklahoma medical schools, the Cleveland Clinic and on Medscape.
Drug companies also used CME courses to raise "awareness" of diseases for which they had new drugs or approvals. When Lilly's antidepressant Cymbalta got FDA approval to improve functioning in fibromyalgia patients, Lilly gave nonprofits$3.9 million in CME grants to raise "awareness" of fibromyalgia. Have drug; need patients.
It should be no surprise that drug companies are sponsoring fewer CME courses as awareness of conflicts of interest and slanted science grows. In fact, one CME provider wondered if providers will soon be turning to Coca-Cola for sponsorships.