John Mack has a fairly brilliant post on his Pharma Marketing blog comparing big pharma and big oil — specifically, J&J and BP — that you have to check out for the photos of a pharma exec testifying and a deer with an alarmingly similar similar expression, if nothing else.

It sounds like the show floor at the recent annual meeting of the American Psychiatric Association in New Orleans was a little sparse. On the scene, Dr. Carlat poked around and heard that “ever since the drug companies had stopped giving out free gifts, the attendance at exhibit halls was down.” Another person told him that foreign attendees also were fewer now.

And yet the latest CEIR Index found medical tradeshows actually outperforming other sectors (only government shows were doing better than medical). Of course, outperforming doesn’t mean much when you can do it while still being down 6 percent when it comes to exhibitors and attendees.

Then there are the outliers, like the Anxiety Disorders Association of America, which actually grew its attendance 50 percent this year. Not without a fair amount of work, though.

There’s no free lunch, and there’s no free CME–everything has a cost associated with it, whether or not you have to shell out any actual dough. Check out this post from Floyd Pennington on why he thinks physicians should have to pay for every credit they earn.

While I appreciate the sentiment, I’m not sure I fully agree with him. He says, “When there is all of this ‘free’ CME out there it is may be too easy to just take what is readily available at no cost and many times probably with no relevance to the patients they are seeing.” But he also points out the growing number of these free activities, and their often high quality. Chances are, HCPs can find a ‘free’ activity for what they really do need to know to improve care for their specific crop of patients, and will if they can. While everyone tends to value things that have a cost associated with them more than freebies, as any meeting professional would attest, if this is the direction we’re going in, I’m not convinced that docs would — or would have to — choose ‘free’ over quality and pertinent education.

But what do I know — I’d rather hear your thoughts on the value of ‘free’ CME.

Here’s an interesting post from the Crikey Health Blog: Evidence-based medicine or marketing-based medicine? It’s well worth a read, particularly since CME is so focused on teaching EBM nowadays.

I got this press release this morning and, while acknowledging that in fact I would rank things pretty similarly, still found it a bit shocking for some reason:

Google second only to doctors as source of health information

Capstrat-Public Policy poll analyzes how people seek medical answers;

Web searches popular, but advocacy groups more trusted

RALEIGH, N.C., May 2010 – A national survey finds Americans rely highly on Google searches as a source of health care information. The survey, conducted in April 2010 by Capstrat and Public Policy Polling, finds 22 percent of respondents consider Google searches “influential” in seeking health information. The search engine ranked second only to doctors (44 percent) in reported influence and was named more than twice as often as nurses, pharmacists, advocacy groups and friends or family members.

After asking where people turn to for health information, the poll asked which sources they trust. Health advocacy groups emerged as a particularly trusted source of online health information: 71 percent judged Web content of such groups “somewhat reliable” or “extremely reliable,”considerably higher than the 59 percent who felt that way about organic Google searches.

Online communities aren’t yet a major influencer in health care. Only 12 percent of respondents used online forums in their last search for health information, and only 37 percent considered forums “somewhat reliable” or “extremely reliable.” Of those who did look to online communities, the number one reason was their around-the-clock availability.

The survey revealed significant differences in the way various segments of society use online communities. African Americans and Gen-Xers are significantly more likely to consider them reliable sources of information. Younger respondents were also much less likely to see pharmacists as reliable sources of information, perhaps reflecting the more impersonal relationship they have with chain pharmacists compared to their parents’ long-standing reliance on the mom-and-pop operations that used to dominate the landscape.

“We found it interesting that popularity and trust don’t always go hand-in-hand,” said Karen Albritton, Capstrat president. “People are quick to search the Web for health information, just as they use it for most other questions today. But when it comes time to make a decision, their trust resides where it always has – in people. This insight can be instructive to organizations working to combine health expertise with new strategies for communication.”

Other notable findings:

· 32 percent of African Americans cited Google as the most influence source for health decisions, compared to only 15 percent of Hispanics who found Google influential

· 63 percent of women considered Google reliable on health, compared to 53 percent of men

· 53 percent of respondents ages 30 to 45 found online forums to be reliable, compared to only 37 percent of respondents ages 46 to 65

· 65 percent found a phone conversation with a nurse to be somewhat or extremely reliable

For a white paper on these results, please visit http://o.capstr.at/t. To view complete survey results, visit http://o.capstr.at/x.

Thomas P. Stossel, a staunch defender of industry/provider collaboration who testified before the Senate Special Committee on Aging last summer, has published his latest salvo, called Unhealthy Opposition

The value of academic-industry relationships, in the Boston Review. It’s well worth a read, whichever side of the fence you reside on. Though he doesn’t dwell too much on the CME angle and is fairly broad in his approach, I think he scores some good points.

(Thanks to Thomas Sullivan at Policy and Medicine for the pointer.)

Marcia Angell, MD, formerly editor-in-chief of the New England Journal of Medicine and a vocal critic of industry-physician collaboration, has a new editorial in the Boston Review outlining how she believes pharma dollars influence healthcare research and education. She says, “Conflicts of interest are … troubling in medical education, where industry influence is perhaps greatest and least justified. The pharmaceutical industry devotes much, if not most, of its vast marketing budget to what it calls the ‘education’ of doctors. The reason is obvious: doctors write the prescriptions, so they need to be won over.”

She’s particularly critical of medical education companies, which she says basically allow pharma companies to provide “marketing masquerading as education.” NAAMECC, time to write a rebuttal, don’t you think?

She also says that “CME is supposed to be free of drug-company influence, but incredibly these private educators have been accredited to provide CME by the American Medical Association’s Accreditation Committee for Continuing Medical Education—a case of the fox not only guarding the chicken coop, but living inside it.”

To which I say, huh? If she means the Accreditation Council for CME, someone should tell her that the AMA doesn’t own ACCME; it is just one of seven member organizations (the others being the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards).

And it appears that’s all she has to say about rules and regs around CME, since she doesn’t mention anything about the Standards for Commercial Support, which exists to rein in exactly the type of industry influence she says CME is rife with, or the ACCME’s accreditation criteria, which are designed to ensure that accredited providers offer real education that leads to better healthcare outcomes, not “marketing masquerading as education.”

While no one is saying the accreditation process is 100 percent effective at preventing any and all abuse, by totally ignoring the safeguards, I think she undermines her argument considerably (maybe someone can point her towards our CME Rules and Regs page for a refresher. Hmm, and I wonder what she’d have to say about this study that found commercial support didn’t result in bias, and in fact found commercially supported CME less biased than that which wasn’t underwritten by industry? But I digress.).

Her solution? “[Doctors] should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard.” I wonder if she’s read this column, which explains why physician education is not comparable to, say, that of lawyers? Not that I necessarily disagree that it would be nice if we could provide what HCPs need in education independently of pharma company support, but nothing I’ve seen or heard tells me that anyone thinks this is a realistic goal. And it wouldn’t eliminate all bias anyway, since I’ve yet to meet a human who didn’t have opinions and worldviews of their own that could sneak into a presentation, even if the person had never taken as much as an aspirin in his or her life, much less owned stock in a drug company, had a cousin who worked in pharma, seen a TV drug commercial…you get the drift.

But it’s a very compelling read, with lots of high dudgeon, and she does make some interesting points. Just not in the education piece of it, where I think she simplified her argument too much, glossing over some pretty key things to get where she wanted to go. As any provider knows, everything about CME is very nuanced, and both the problems and the solutions can be found in the details. If she wrote this 20 years ago, perhaps I’d find it more credible. But we’ve come a long way since then, something which Angell conveniently ignores to score her points.

Other related blog posts:

Boston Review: Boston Unscientific — Selling Fiction (Thomas Sullivan, Policy and Medicine)

Great New Article by Dr. Angell (Daniel Carlat, MD, The Carlat Psychiatry Blog)