Here’s an editorial by Jerome P. Kassirer from yesterday’s Boston Globe that points to meetings specifically as being one of pharma’s media of influence over physicians. He uses the recent $185 million class action lawsuit against Bristol-Myers Squibb —specifically, how “Bristol-Myers Squibb-paid physicians in major medical meetings were shamelessly exaggerating the benefits of the drug for patients with high blood pressure and heart failure and failing to report publicly on substantial numbers of life-threatening drug complications which they knew, from their close relationship to the company, to exist.” More from his editorial:

The BMS settlement exposed a well-hidden method of influencing doctors. The biased talks were given in ‘’symposia” at major national medical meetings of major medical organizations such as the American Society of Hypertension and the American College of Cardiology. Symposia, little known to the public, are special events, usually lectures by leaders in the field, sponsored by drug and device companies and typically held in the morning before the official program or in the evening following the day’s usual program. Nice snacks and drinks are often served and sometimes dinner also. As hard as they try to be objective, the speakers’ financial ties to the industry often create subtle (or even overt) biases that induce them, either consciously or subconsciously, to adhere to the company line. From the experience with Vioxx, we learned that if they stray from the company’s message, they may not last long as a paid speaker. (For perspective, the preliminary program of the American Psychiatric Association’s June 2006 meeting in Toronto features at least 46 such symposia, sponsored by the major companies that make the drugs that psychiatrists prescribe.) What the APA gets for this collaboration with industry and what industry gets in return is not public knowledge.

In case you’re not sure how well-prepared healthcare workers feel when it comes to a possible avian flu pandemic, this survey of primary care physicians by Pri-Med Research should eliminate any doubts:

Fewer than one in five primary care practitioners believe they are adequately equipped today to treat infected patients. Over 50% express little or no confidence in the government’s ability to manage a flu pandemic at the local, state, federal or international level. 91% of practitioners surveyed also feel that the current availability of anti-viral medications is inadequate to meet an avian flu crisis. A substantial majority would rely on the Centers for Disease Control (CDC) and their local public health authorities for guidance in responding to any outbreak.

If you’re interested in responding to this particular needs assessment, check out this article I wrote about disaster preparedness training. And please invite my primary care physician to attend.

From the Washington Post: Cleveland Clinic to Tighten Its Disclosure Policies. It sounds like all the bad press the clinic received last year over ties its doctors had with companies that make the products and procedures it was testing prompted them to ask lawyers from the Chicago office of McDermott, Will & Emory to review what they’re currently doing about potential conflicts of interest. While the final report isn’t yet completed, the clinic’s “institutional review board, which reviews all research involving patients, is being provided with information on investments made by the clinic. In the past, the review board was unaware that the clinic was investing millions of dollars in companies conducting clinical trials and other research work at the hospital,” according to the article.

Considered one of the top heart centers in the world, the Cleveland Clinic also said the review determined that the “clinic has reached a point of imbalance between innovation efforts and transparency” and that “importantly, actions need to be taken to correct the imbalance,” according to Eileen Sheil, a spokeswoman for the clinic.



The review also found fault with the clinic’s chief executive, Delos “Toby” Cosgrove, a renowned heart surgeon, saying that his own disclosure practices “contained some shortcomings,” according to Ms. Sheil. She added that the review indicated those shortcomings weren’t reflective “of a lack of individual integrity.”

It’ll be interesting to see what else the implement, especially in light of all the confusion the Duke study found various medical centers to be having in developing disclosure policies, as I posted about earlier today. Maybe the Cleveland Clinic can set up something that serves as a template for those who are struggling? We’ll see.

According to this press release, it sounds like medical centers are still struggling with finding effective policies about disclosing conflicts of interest (here’s a link to the article about the study in the February 1006 edition of Academic Medicine). From the press release:

Only 48 percent of U.S. academic medical centers have a formal policy requiring that financial conflicts of interest are disclosed to potential participants in their clinical trials, a research team from Duke University Medical Center, Wake Forest University and Johns Hopkins University has found.



Among those institutions that do disclose this information to participants, there was considerable variation in the type of information and the way it is presented to potential research participants, found the researchers.




In their “snapshot” of how academic medical centers are managing the issue of conflicts of interest, the team sought to discover how much, if any, information about corporate sponsorship of clinical trials is reported to potential participants. They also said they hoped their study and others to come will help academic medical centers develop more effective conflict of interest disclosure policies.

Sounds like there’s much more work still to be done in this area before we reach any sort of consensus, if that even is possible. (Thanks to Debra for the pointer!)

According to this article, up to 150 people fell ill at a fundraiser held while people were at the Drake Hotel attending an American Medical Association meeting. Current theory is that a virus is to blame.

Update: I saw an official communique today (Feb. 9) that says it was a norovirus passed by both food and person to person. The outbreak was contained, the hotel thoroughly scrubbed and disinfected, and no new cases have been found.

I love this idea from Tom Peters:

STOP … using the term “healthcare.”

START … using the term “health.”



Better HEALTH is the goal–and if we did “it” (focus on “health”), then “healthcare” would be far, far, far less necessary. (Understatement.)

This has nothing to do with CME, but I thought it was fascinating: HomeWeb game provides breakthrough in predicting spread of epidemics.

Using a popular internet game that traces the travels of dollar bills, scientists have unveiled statistical laws of human travel in the United States, and developed a mathematical description that can be used to model the spread of infectious disease in this country. This model is considered a breakthrough in the field.



“We were confident that we could learn a lot from the data collected at the www.wheresgeorge.com bill-tracking website, but the results turned out far beyond our expectations,” said Lars Hufnagel, a post-doctoral fellow at the Kavli Institute for Theoretical Physics at the University of California, Santa Barbara and co-author of an article describing the research in the January 26 issue of the journal Nature.

Bird flu was in the news again last night, freaking me out once again. So, if this works, that’d be great. In the meantime, are you prepared?

I just got an e-mail from someone with a question I can’t answer about California Senate Bill 1765. Does this legislation apply to medical conventions held outside of the state of California where California healthcare professionals attend, or is just intended for when a pharma is in California doing business with a California healthcare professional?

If you know the answer, please drop me an e-mail or leave a comment below. Thanks!

Update: Thanks to Debra Gist, MPH, who recently opened a CME consulting business, for hunting down this advisory on SB 1765. According to attorney John Krave, who wrote the advisory, this is still a gray area:

Unclear Geographical Limits. SB 1765 applies to pharmaceutical companies that operate within California, but fails to describe the impact of foreign state operations. Does SB 1765 require a company with a California presence to comply with PhRMA marketing limits in its Florida operations? The question is especially difficult if the company operates outside the OIG/PhRMA Guidelines but does not violate any laws in the process. Can the company truthfully post the required declaration if it has engaged in legal violations or has a flawed compliance program in a foreign state or country.

According to this article in the Toronto Star, Ontario has a growing physician shortage it would like to fix. Among the incentives used by other areas in Canada, the article says, is having some provinces (Alberta and British Columbia) subsidize continuing medical education. Makes sense to me.

According to this Wall Street Journal article (subscription req’d), resolving author conflicts by disclosing them in a correction after the fact ain’t going to cut it anymore. From the article:

Andrew Wechsler, editor of the Journal of Thoracic and Cardiovascular Surgery, says the publication plans to issue corrections in the two cases to reveal the financial ties of the researchers to AtriCure Inc., a Cincinnati company that makes a system to treat atrial fibrillation, an abnormal heart rhythm.



Prompted by the AtriCure revelations, the American Association of Thoracic Surgery, which owns the journal, decided that a published correction of a conflict of interest — a common remedy when authors fail to disclose industry links — doesn’t go “far enough,” Dr. Wechsler says. He says the tougher sanctions approved by the surgery society will include barring those individuals and their institutions from publishing in the journal for “some period of time.”

I know I’ve heard of some specialty societies having similar policies for CME faculty, and I can’t help but wonder if tougher sanctions for those who fail to disclose conflicts of interest might be coming to a broader realm.