Physicians in Scotland are being wooed—but this time, the wooer isn’t big pharma. It’s big milk, as in formula milk companies who are providing all kinds of goodies in hopes the docs will recommend nursing mothers to choose formula. From The Sunday Times:

“Paediatricians were taken out to dinner and the opera at Glyndebourne by formula milk companies and air fares have been paid for doctors to attend a meeting in Switzerland,” he said.



While the payment of travel and accommodation expenses to doctors is shrouded in secrecy, sponsorship of medical events by formula manufacturers is commonplace.




Last year, Wright and other paediatricians boycotted the annual meeting of the RCPCH in Scotland after the event was sponsored by SMA Nutrition, one of the leading infant formula milk manufacturers.




The company also ran a competition for doctors to win an all-expenses paid trip “covering travel and accommodation costs up to £400” to attend one of its study days. In addition, the company has run competitions for doctors to win SMA-branded toy boxes for their waiting rooms.

After musing about using multimedia for online CME cases, I got to speak with Destry Sulkes, MD, managing director of MedsiteCME, which recently started incorporating multimedia into its online cases.

Me: Where did the idea to incorporate multimedia in your online cases come from?



Sulkes: I used to do almost NASA-grade simulations of patient interactions. But downloading times were long, streaming was tough, and doctors became confused. It just got a little too complex. So at MedsiteCME what we do is strip our cases to be as simple as possible. You read a screen, get a question, click to get the answer, and move on to the next screen. Then we have some faculty who said, ‘Here are the cases and the 15 questions, but you really can‘t explain the resolution of cervical dystonia unless you show a video of a patient before and after treatment.” Then we got another one where someone said we‘re not sure you can tell the difference between pseudo epileptic seizures and epileptic seizures, so he sent some video on that. Then we got another case where we wanted to talk about cerebral palsy injections with Botox, and how to inject the right muscles so you release the contractures but not the wrong muscles and/or arteries, veins, and nerves. So we created a 3D animation on where to insert the needle and how to validate you‘re in the right spot. They‘re just little snippets, five to 10 seconds long, and they‘re persistently available throughout the case so they can go back to the media at any time.




Me: Have you done any outcomes measures to see whether the cases with animations have better outcomes than the plain cases?




Sulkes: We haven‘t assessed these cases versus other cases. What I don‘t want to do is say a case with video is better than a case without video. It depends on the case, the faculty, the structure of the case, and the learning objectives. The video might zap the learning objective and have a high impact on the doctor. But if you drop an animation into the wrong case it can be disruptive and boring and cause the doctor to leave the case. You don‘t want to have media for media‘s sake. You choose the format and the media for the learning objectives and the audience. It changes. You need to be at a national society meeting, and online, and on teleconferences, but you‘re achieving different objectives and you‘re getting different outcomes with each one of those. You can‘t really take one yardstick out and say what are the outcomes for an online case versus a society meeting.




Me: Do the physicians seem to like the multimedia additions, whether or not they affect outcomes?




Sulkes: Most of our doctors are repeat users of our site and they know what we offer. We get a lot of “appreciate the animation,” and “like the video of the patient.”

What I’d be curious to know is if anyone has done two identical cases—same faculty, same case, same learning objective, etc.—with the only difference being that one includes multimedia and one doesn’t, and then measured the outcomes. If anyone has done such a thing, please drop me an e-mail or leave a comment below.

Here’s a great article from Fast Company about how the Mayo Clinic is encouraging innovation by asking its doctors to think more like designers. Fascinating!

From Capsules co-blogger Anne Taylor-Vaisey: We all talk about the importance of critical appraisal. When I’m reading health stories in newspapers or hearing them on the news, I always wonder about the quality of the information reported. Well, I just came across a really interesting site, Read about it here.

Tuesday, April 25, was “Code Day” in the UK, where 8,000 pharma reps set out to detail docs and others on their industry’s code of ethics. From MedicalNewsToday:

On CODE Day, pharmaceutical sales representatives and other industry employees who contact health professionals, patient organisations, professional bodies, the media, members of the general public and MPs dedicated time to discussing the 2006 edition of the ABPI Code of Practice. This combined effort aims to draw attention to how tightly regulated the industry is, how it operates to the highest ethical standards, and the rigid sanctions on companies that breach the code. All stakeholders will also be informed about how to make a complaint.



All aspects of the promotion of medicines - advertisements, representatives’ activities, meetings and hospitality, as well as non-promotional activities, such as co-operation with patient groups, the provision of education, and information to the public - are self-regulated through the pharmaceutical industry’s code. Yet research has shown that 48 per cent of doctors interviewed were unaware of the code, while 86 per cent had no knowledge of how to make a complaint, and 57 per cent would like to have more information about it.

According to this Reuters story, Senator Grassley now is asking “for Congress to give the Food and Drug Administration more power to review drugs after they are approved for the public, citing a government report that found lingering safety concerns at the agency.” More from the article:

“FDA lacks a clear and effective process for making decisions about, and providing management oversight of, postmarket drug safety issues,” the GAO report said. “We observed that there is a lack of criteria for determining what safety actions to take and when to take them.”



The FDA sometimes approves products under the condition that companies later provide more data, but it lacks the authority to require such studies in most cases. The GAO said longer trials after approval could “answer safety questions about risks associated with the longer-term use of drugs.”

Thanks to Deb for the pointer!

Med ed company Scinexa has won a Bronze 2006 Summit Creative Award in the Interactive Media in the Education category for its CMEdiscovery.com online continuing medical education activity and accompanying CD-ROM, “Challenges in Dosing Low Molecular Weight Heparin.”. According to a press release, the program was scored among the very best in creative execution and overall quality.

Kudos to Advanced Health Media, which provides customizable technology for compliant pharmaceutical meetings, speaker programs and health care professional interactions, for being named as one of the “Best Places to Work in New Jersey,” by NJBIZ. Roche and Novo Nordisk also made the list. AHM was lauded for its staff evaluation and its assessment of its workplace policies.

According to Yahoo:

Wolters Kluwer Health, a leading global provider of drug and medical information services and content to the pharmaceutical and biotechnology industries, today announced that it has separated its continuing medical and pharmacy education unit into a subsidiary company. The new entity, Lippincott Continuing Medical Education Institute, Inc. (LCMEI), is based in Yardley, Pa. This move helps strengthen the firewall between its accredited education services and other company products.

I think we’ll continue to see more of this as pharmaceutical companies continue to tighten their commercial support firewall requirements, as I reported about in this article.

MedsiteCME now incorporates multimedia into its CME case studies, which I think is a terrific idea. From the press release:

The animated video provides a visual component to existing text-based copy, enabling healthcare professionals to visualize procedures and anatomy in an interactive manner and providing a more enriching learning experience.



“The addition of multimedia to our case-based CME programs enables our physicians to view and interact with patient video, diagnostic imaging and animated mechanisms that are otherwise unavailable,” said Destry Sulkes, M.D., Managing Director of MedsiteCME. “While we can’t actually ’see one, do one, teach one’ online, this is the next best thing.”

I’d be curious to know if many other providers are already doing this, and if it does actually increase learning and retention. I have a call in to find out more behind the decision to go this route, and will let you know what I find out. Or maybe my co-blogger, Anne Taylor-Vaisey, can dig up a study or two about it. I remember reading something somewhere, but can’t put my finger on it.