Medical Communication Companies Research Articles

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CME Companies Tracking M.D.s’ Personal Information

Back to table of contents Previous article Next article Professional NewsFull AccessCME Companies Tracking M.D.s’ Personal InformationVabren WattsVabren WattsSearch for more papers by this authorPublished Online:7 Feb 2014https://doi.org/10.1176/appi.pn.2014.2a4AbstractExperts say “free” online CME courses often come with a hidden price; namely, the sacrifice of some degree of privacy.Medical communication companies (MCCs) are doing more than offering online continuing medical education (CME) courses to physicians—the companies may be monitoring clinicians’ website behavior as well. Researchers from the Mailman School of Public Health and the Center for the Study of Society and Medicine at Columbia University investigated the financial relationship between MCCs and drug companies and whether MCCs accurately represent themselves to clinicians using their CME offerings. They reported their findings in the December 18, 2013, Journal of the American Medical Association.“Our center primarily focuses on conflicts of interests as they relate to pharmaceutical companies,” Shelia Rothman, Ph.D., lead study author and deputy director of the Center for the Study of Society and Medicine, told Psychiatric News. “We began with simply observing grant registries of these companies and wondered if they used biases in regard to awarding grants to certain individuals, health organizations, or academic institutions.”Mathias Rosenthal/ShutterstockRothman and colleagues evaluated the grant-giving practices of 15 pharmaceutical and medical-device companies that provided a complete report—all four quarters—from Fiscal 2010. Some major industry names that were included were Bristol-Myers Squibb, Merck, and Forest Laboratories. The researchers reviewed more than 19,000 grants that were given to 6,493 recipients. The grantees were divided into multiple categories including MCCs, academic institutions and affiliated hospitals, and disease-targeted advocacy organizations.Data showed that of the $657 million in grant money awarded by the drug and device companies, 26 percent was allocated to MCCs, followed by academic medical centers at 21 percent and disease-targeting advocacy organizations at 15 percent. Eighteen MCCs received more than $2 million each in funding. Of those heavily funded MCCs, 99 percent offered free online CME courses, and approximately 60 percent of these companies acknowledged using cookies and Web beacons to track physicians’ online activity, in addition to sharing physicians’ personal information—such as demographics, professional specialty, and license number—with third parties including “educational partners” and companies with which they have a working relationship. “Industry contracts with MCCs are not publicly available, which made it difficult to thoroughly investigate MCCs’ relationships to industry and to physicians,” Rothman told Psychiatric News. “I hope medical professionals began to explore what is going on with online CME training. Physicians should be able to feel that these [medical communication] organizations are acting in their best interest.”According to the study authors, although MCCs did not elicit users’ explicit consent, the companies did interpret “participating in a CME course and navigating the [MCCs’] website as an implicit agreement to share information with third parties.” Paul Appelbaum, M.D., a former APA president and the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University College of Physicians and Surgeons, cautioned that “even ‘free’ CME courses come with a price.” He emphasized that information collected by MCCs may be shared with pharmaceutical companies for market research or targeted promotions, leading to physicians being visited by certain drug representatives. Appelbaum, who currently serves as chair of APA’s Committee on Judicial Action, urged all clinicians to evaluate the privacy policies of the sponsoring companies before signing up for CME courses. “If physicians aren’t comfortable with the amount of information they will be revealing, they should decline to participate,” he said. ■“Medical Communication Companies and Industry Grants” is posted at http://jama.jamanetwork.com/article.aspx?articleid=1790870. ISSUES NewArchived

Medical Communication Companies and Continuing Medical Education

It’s always intriguing toopene-mail in themorningand lookat thelatestcropofcontinuingmedicaleducation(CME)invitations. Anddream.Whowouldn’twanttogotoMauitodiscusscommon issues in primary care? Or traveltoCancuntolearnabout using laboratory and clinical parameters to assess cardiovascular risk.Butgettingtimeoffcanbedifficultandtravel is increasinglyexpensive.Fortunately,abundantCMEopportunities areavailableonline.Physicianscanmeet licensurerequirements without leaving home andoften cando so for free. Wheredoall theseCMEinvitationscomefrom?Manycome frommedical communicationcompanies, largely for-profit entities that create, organize, promote, and run CME activities. Instead of CME, however, some medical communication companiesfocusonpromotionalservices,suchasrecruitingand trainingforthepharmaceuticalcompany’sspeakersbureausand preparing their slidedecks; assistingwithpublicationplanning formedical journalarticles,orevenwriting them.Somecompanies engage in both promotion and education. But that can be problematic.Educationshouldbeevidencebasedandunbiased: gettingcliniciansthefacts.Promotion is,well,promotional:persuadingclinicianstouseaparticularproduct.Companiesthatdo bothpromotion andeducation are required tomaintain a strict “firewall” between these activities—no contact between teams working in the sameclinical arena.Theobvious concern is conflictof interest.Withoutastrict firewallbetweenpromotionand education, promotional interestsmay bias educational efforts. Medicalcommunicationcompaniesmustbecertifiedbythe AccreditationCouncilforContinuingMedicalEducation(ACCME) for their CME to count toward licensing requirements. Accreditationstandards includeestablishing that industry clientswere not involved in the creationof theeducational activity and that presentations are balanced andunbiased. TheACCMEcertifiesCME for abroadarrayof clinicians including trainees. Most CME participants are physicians, but nonphysicians (eg, nurse practitioners, physician assistants) are catching up. From2003 to 2012, the number of physicians participating inCME-accreditedactivities increased133%from about 6million to 14millionparticipants. (Participants canbe countedmore than once depending on the type of CME activity.) Fornonphysicians, participation increasedby233%, from about 3million to 10million.1,2Medical communication companies account for only 7% of all accredited CME organizations, yet they account for 30% of physician and 43% of nonphysician participation in CME activities.1 Whodothemedicalcommunicationcompaniesworkfor?Industry accounts forhalf of the revenueofmedical communicationscompanies.3However,detailsaboutactualfinancialarrangementsaresparse.InthisissueofJAMA,Rothmanetal,4shedsome light intothis largelyunexploredworld. In2010,asaresultofvoluntaryandDepartmentofJusticerequiredactions,14drug-device manufacturerspostedgrant registriesontheirwebsites.According to the analysis of these registries by Rothman et al,4 the 14 companies issuedmorethan$650millioninnonresearchgrants. Almostone-thirdof thegrantmoneywent tomedicaleducation companies,morethananyothercategoryofrecipient:academic medical centerswereaclosesecondanddisease-targetedadvocacy groups were close behind. Medical communication companies were the leading grant recipients for 10 of the 14manufacturers (or 8 of 11, if the analysis was restricted to largest manufacturers—top20 forUSpharmaceutical sales).According to the report byRothmanet al,Medscape/WebMDreceived the most support by capturing 12%of the grantmoney. Medical communication companies' reliance on industry fundinghighlights the importanceofkeepingpromotionseparate fromeducation.All companieswill feel unconscious (and perhaps explicit) pressure to present their clients’ products in the best light. Bias can easily occur in the selection and training of speakers, in their presentations, on the websites, and even in test questions. Industry's adherence with regulation is concerning, particularly for thepromotionof off-label uses. In 2007, for example, the US Senate Finance Committee held hearings on industry conflicts of interest and noted that

Medical Communication Companies and Industry Grants

Medical communication companies (MCCs) are among the most significant health care stakeholders, supported mainly by drug and device companies. How MCCs share or protect physicians' personal data requires greater transparency. To explore the financial relationships between MCCs and drug and device companies, to describe the characteristics of the large MCCs, and to explore whether they accurately represent themselves to physicians. We combined data from the 2010 grant registries of 14 pharmaceutical and device companies; grouped recipients into categories such as MCCs, academic medical centers, disease-targeted advocacy organizations, and professional associations; and created a master list of 19,272 grants. Determine the distribution of funds from drug and device companies to various entities and assess the characteristics of large MCCs. Of the 6493 recipients of more than $657 million grant awards from drug and device companies, 18 of 363 MCCs received 26%, academic medical centers received 21%, and disease-targeted organizations received 15%. For-profit MCCs received 77% of funds (208 of 363). Among the top 5% of MCCs, 14 of 18 were for-profit. All 18 offered continuing medical education: 14 offered live and 17 offered online CME courses. All required physicians to provide personal data. Ten stated that they shared information with unnamed third parties. Eight stated they did not share information, but almost all added exceptions. None required explicit physician consent to their sharing policies. Medical communication companies receive substantial support from drug and device companies. Physicians who interact with MCCs should be aware that all require personal data from the physician and some share these data with unnamed third parties.

Ghost- and Guest-Authored Pharmaceutical Industry–Sponsored Studies: Abuse of Academic Integrity, the Peer Review System, and Public Trust

Industry-sponsored ghost- and guest-authored clinical research publications are a continuing problem in medical journals. These communications are written by unacknowledged medical communication companies and submitted to peer-reviewed journals by academicians who may not have participated in the writing process. These publications, which are used for marketing purposes, usually underestimate the adverse effects and medical risks associated with the products evaluated. Since peer-reviewed data are used to develop health care paradigms, misleading information can have catastrophic effects. A failure to curb ghost and guest authorship will result in an erosion of trust in the peer-review system, academic research, and health care paradigms.

Adapting to Decreased Industry Support of CME: Lifelong Education in an "Industry-Lite" World

The continuing medical education (CME) enterprise in academic medicine is changing rapidly because of a number of important factors: the change in CME doctrine promulgated by the Accreditation Council for Continuing Medical Education (ACCME) (1), the refinement of the criteria for maintenance of certification (MOC) by the American Board of Medical Specialties (ABMS) (2), and alterations in patterns of commercial sponsorship for educational events by pharmaceutical and device industries. This article focuses on how alterations in the patterns of commercial support for educational events at academic medical centers and universities are changing the CME opportunities for faculty and trainees associated with academic departments of psychiatry. Historically, commercial funding has subsidized and supported considerable CME activity in academic medical centers. A 2006 survey (3) indicated that 49% of CME course costs at academic centers were funded by industry. Commercial sponsorship of CME has taken several forms. Commercial companies, either directly or through their educational intermediaries, have sponsored Grand Rounds speakers in academic departments, either as members of speakers’ bureaus or via individual grants. These companies have also helped underwrite the costs of CME conferences sponsored by academic departments through their universities. Also, commercial companies have sponsored journal clubs and dinner meetings with speakers for practitioners in the community, often at reasonably attractive restaurants, as well as travel funds for faculty, residents, and fellows to attend national and international meetings. Through “medical education and communication companies,” which have frequently partnered with academic departments of psychiatry, industry has sponsored educational activities with online options, teleconferences, and videoconferences and the development and production of CME events in conjunction with professional-association meetings. Traditionally, these offerings feature top names and excellent media production, and they draw large audiences. Thus, increased levels of commercial support have helped proliferate different approaches for physicians to receive free CME. At times, these presentations may become vehicles for commercial entities to “educate” practitioners in a manner that is conducive to acceptance of a product or a specific class of agents for treatment interventions. In 2008, pharmaceutical and medical-device companies funded half of the $3 billion CME industry, and much of this money was directed to for-profit medical-communication companies that organize CME programs and symposia (4). Well-warranted concerns about ethics issues and the educational implications of marketing biases and academic leaders’ industry ties (5), raised by public scrutiny, Congressional investigations, and leaders in the medical profession, have led pharmaceutical and device companies to revise their funding patterns and practices. The overall effect has been a severe curtailment of industry funding of CME activities. Academic departments and organizations that relied on commercial largess have been increasingly deprived of the funds previously available for CME activities. According to industry sources, many providers now Received December 20, 2009; revised March 7, 2010; accepted March 8, 2010. Dr. Yager is affiliated with the Department of Psychiatry at the University of Colorado, Denver. Dr. Silverman is affiliated with the Department of Psychiatry at Virginia Commonwealth University in Richmond, VA. Dr. Rapaport is at the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, and the Department of Psychiatry and Bio-Behavioral Sciences, University of California, Los Angeles. Address correspondence to Joel Yager, Department of Psychiatry, University of Colorado, 13001 E 17th Pl, A011-04, Aurora, CO 80045; jyager@unm.edu (e-mail). Copyright © 2011 Academic Psychiatry

Backers Warn of Major Fallout if Industry CME Funds Banned

Backers Warn of Major Fallout if Industry CME Funds Banned