I’ll probably be a little quiet the rest of this week as I run myself ragged at the 1st Annual Pharmaceutical Meeting Planners Forum, a meeting we’re putting on in conjunction with the Center for Business Intelligence. For the ins and outs of my foray into the on-site world of meeting planners, visit face2face, our meeting planner blog. In the meantime, here’s a reminder from my Capsules co-blogger, Anne Taylor-Vaisey: National Task Force on CME Provider/Industry Collaboration, October 24-26, 2005 in Baltimore, MD

The American Medical Association and the National Task Force on CME

Provider/Industry Collaboration will host, The 16th Annual Conference of the National Task Force on CME Provider/Industry Collaboration “Practical Strategies for Survival in the Guideline-rich Environment of 2005″ on October 24-26, 2005. The conference will be held at the beautiful Baltimore Marriott Waterfront Hotel in Baltimore, Maryland.

This post courtesy of Anne Taylor-Vaisey:

The following list is a from a table in the following article:

Grudzen CR. One resident perspective: resident education and the pharmaceutical industry. Ann Emerg Med 2005; 45(1):27-31.

Web sites for ethical guidelines for gifts to physicians

American College of Physicians

American Medical Association

American College of Emergency Physicians

Society of Academic Emergency Medicine



Canadian Medical Association

British Medical Association

Royal Australian College of General Practitioners

To comment on this post, click on “comments” below. To receive a weekly update, e-mail Sue.

This post courtesy of Anne Taylor-Vaisey: Just by chance, this abstract from the latest issue of JAMIA just popped up in my e-mail. The authors of this study asked practicing physicians what there information needs are. They asked them for their recommendations, and these are available in an appendix. The bottom line is, physicians seeking answers to questions at point of care don’t have time for literature searching. They need immediate answers and want to see resources developed that provide those answers.

Of course, this scenario differs from that of the health care provider or researcher who is doing in-depth literature searching for a self-directed learning project or for publication. What is the best way to teach searching skills to that kind of learner?

__________________________________________________________

Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc 2005; 12(2):217-224.

OBJECTIVE: To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information resources.

DESIGN: Qualitative analysis of questions asked by 48 randomly selected generalist physicians during ambulatory care.

MEASUREMENTS: Frequency of reported obstacles to answering patient-care questions and recommendations from physicians for improving clinical information resources.

RESULTS: The physicians asked 1,062 que! stions but pursued answers to only 585 (55%). The most commonly reported obstacle to the pursuit of an answer was the physician’s doubt that an answer existed (52 questions, 11%). Among pursued questions, the most common obstacle was the failure of the selected resource to provide an answer (153 questions, 26%). During audiotaped interviews, physicians made 80 recommendations for improving clinical information resources. For example, they requested comprehensive resources that answer questions likely to occur in practice with emphasis on treatment and bottom-line advice. They asked for help in locating information quickly by using lists, tables, bolded subheadings, and algorithms and by avoiding lengthy, uninterrupted prose.

CONCLUSION: Physicians do not seek answers to many of their questions, often suspecting a lack of usable information. When they do seek answers, they often cannot find the information they need. Clinical resource developers could use the recommendations made by practicing physicians to provide resources that are more useful for answering clinical questions.

PubMed link

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From Pharmaceutical Executive :

In 2002 it was the PhRMA Code, in 2003 it was the OIG’s Guidance for Industry, and in 2004 it was Justice Department enforcement. Now, in 2005, it appears that regulation of the US pharma industry has a new focal point state legislatures.

I recently posted about how the Office of Professional and Continuing Education at the University of North Texas Health Science Center received a perfect score during its reaccreditation by the American Osteopathic Association, the national professional organization for osteopathic physicians. And now I heard it was awarded Accreditation with Commendation last week, putting the program in the top five percent of all providers of continuing medical education in the United States. PACE received exemplary compliance in three parts of Essential Area 2, Educational Planning and Evaluation, including its use of needs assessment data, activity evaluation, and overall continuing medical education program evaluation.

Kudos again to PACE. And if you have anything you’d like to crow about, please e-mail me the news!

According to this article on Jersey.com, New Jersey has become the first state in the U.S. to pass a law that mandates docs be educated on the unique needs of patients from different cultural backgrounds:

When white people are diagnosed with diabetes, their doctors tend to prescribe a healthier lifestyle. When black people are diagnosed with the same disease, their doctors hospitalize them.

According to state Sen. Wayne Bryant, this discrepancy happens in about 75 percent of diabetes cases. He said the health care industry is riddled with similar racial, cultural and ethnic inequalities.

On Wednesday, Bryant looked on as Acting Gov. Richard Codey signed Bill S-144 into law at the University of Medicine and Dentistry of New Jersey (UMDNJ). The bill mandates that all physicians in the state submit to cultural competency training. It applies both to physicians still in training and those who have already received their licenses.

"We have an obligation to recognize the unique needs of our diverse community," said Codey. "One area where we need to be especially sensitive to the needs of minorities is health care."

The article also says that Arizona, New York, California and Illinois are considering similar proposals. We’re thinking about doing an article on all this for an upcoming issue, so if you have any thoughts on this, please give me a call at (978) 448-0377, or drop me a line at spelletier@charter.net

I thought it was interesting–and somewhat bold–for the Southern Medical Journal to devote its December issue’s continuing medical education section to spirituality in health care. (See article about it in Theology News.)

 This is the first time that a major mainstream medical journal has devoted an entire issue to religion, spirituality and medicine, said [Dr. Harold Koenig, a contributor to the journal s special issue and editor-in-chief of Science & Theology News].

 It sends the message that this is an important area that doctors can no longer ignore. That message is critical at this particular time in the growth of this field.

A reader today e-mailed me with a question I don’t really have an answer to, so I thought I’d ask you all: She said she was hearing that some pharma companies are requiring site visits for CME providers whose programs they might provide commercial support for, and was wondering how widespread that requirement might be.

This did come up at a session at this year’s Alliance for CME meeting. The panel of pharma folks seemed to agree that it was becoming fairly common to grill medical education and communication companies to make sure that they have the right firewalls in place–including physical separation between education and promotional arms. Some mentioned that a site visit could be a possibility, but it didn’t sound like it was really widespread, and they only mentioned it in connection with MECCs, not other provider types.

That’s really all I know about it–if you know anything more definitive, could you please e-mail me or drop a note in the comments section below?

To receive a weekly update, e-mail Sue.

Did I mention that the March/April issue of Medical Meetings just went up on our Web site? You can view it here. There’s a lot of good stuff, including what I think is downright exhaustive coverage of this year’s Alliance for CME meeting, particularly the sessions on the ACCME’s Standards for Commercial Support. The best one is probably the cover story, Don’t Panic!.

A guest blog from Medical Meetings’ editor, Tamar Hosansky, from her editorial in the March/April issue:

At my first continuing medical education professionals’ meeting, the 1997 American Medical Association CME Provider/Industry Collaboration Conference, I had a breakfast conversation that I’ve never forgotten. A CME provider told me how his organization worked with pharma companies to develop marketing programs for new drugs. The strategy involved producing CME activities that created cognitive dissonance  in other words, generated dissatisfaction  among physicians about existing treatments; then, the new product would be introduced as an improvement. I don’t recall him saying anything about whether the new products were actually better for patients than the old ones. The strategy was about how to make physicians think that they were better so that they would prescribe them. He was describing using CME and the learning theory of cognitive dissonance to manipulate doctors.

Fast-forward to the 2005 Alliance for CME conference in January. I was struck by the difference in tone. Sessions addressing how to develop ethical collaboration between the pharma industry and CME providers were packed, as were sessions concerning the Accreditation Council for CME’s updated Standards for Commercial Support. As we report in our cover story, beginning on page 26, attendees focused not only on how to follow the letter of the new rules but also discussed how to really ensure that CME is truly objective and balanced.

One of the major hurdles CME providers face is educating faculty and participants about conflict of interest. As Murray Kopelow, MD, ACCME, pointed out at the conference, physicians don’t want to believe that commercial support of CME can influence their prescribing choices. Here’s where cognitive dissonance  the uncomfortable feeling you get when you learn something new that challenges your current beliefs  can be put to a positive use. To ensure that CME becomes more independent, providers must create cognitive dissonance among faculty to help them acknowledge the reality that relationships with the pharmaceutical industry may  despite the best of intentions  inject bias into CME.

Providers can not only help faculty question their beliefs, but encourage them to bring the issues out into the open at CME events. For instance, at an Alliance mini-plenary, CME veteran Sue Ann Capizzi proposed that providers ask CME faculty who also serve on pharma speakers bureaus to make a statement to their audiences saying that they recognize the difference between certified CME and promotional activities, that they will not use promotional materials developed by a pharma company in an educational program, and that their presentation will be balanced. Such a statement should cause faculty and participants to reflect on the potential effect of industry relationships on CME content.

Given the complex web of physician/pharmaceutical industry connections, I think it’s unrealistic to believe that CME could ever be completely devoid of commercial influence, no matter what rules or regulations are put in place or where the funding comes from. But I hope that the CME community continues its dialogue about managing conflict of interest and enforcing the new regulations, and that CME professionals’ efforts will eventually result in a different environment  where it is unacceptable to use certified education as a marketing tool.