I don't write typical continuing medical education content. I can't remember the last time I schlepped to an annual CME conference. I have seen the "quality" that self-appointed leaders in the CME world ascribe to and ---no thanks. There isn't much for a data informed writer to contribute within the current ecosystem. The mantra "THIS IS HOW WE HAVE ALWAYS DONE IT" still runs strong through the enterprise. I am unable to align the need to meet client, i.e., sponsor objectives with high quality data or evidence.
Now if you can get past the Sturm und Drang, there are a few ideas and insights to consider.
I am not suggesting anything nefarious but think about this quote, "It is difficult to get a man to understand something, when his salary depends on his not understanding it."--Upton Sinclair
This is more than a business decision. It is a point of worry and concern. If we continue to turn a blind eye to bias and thinly veiled marketing disguised as evidence-based medicine--shame on us.
You might be surprised by the list of the key-tools of non-evidence-based medicine in 2016 (splendlidly serving vested interests) as described by John Ioannidis, MD.
•Practice guidelines based on seemingly rigorous processes
•Systematic reviews and meta-analyses
•Observational studies and risk factor epidemiology
•X-omics, predictive medicine, precision medicine, personalized medicine, individualized medicine
Does it seem odd to you that 96% of the biomedical literature claims statistically signficant findings?
"Drugs can save lives and improve health when used appropriately but Promotion interferes with appropriate use of drugs" -- Adriane Fugh-Berman, MD
This is a list of fines levied against a leading pharmaceutical company. They all have similar pay-outs so I am not going to single-out only this company--but you get the idea.
XXX’s Legal Settlements: 2011 -2015
$2.5 million for inflating drug prices charged NY
$264.9 million for class-action suit
$14.5 million for illegal marketing of drug x
$60 million for bribing foreign physicians
$43 million for deceptive marketing of drug A, drug B
$55 million for deceptive marketing of drug C
$18 million for defrauding Medicaid
$190 million for violating anti-trust laws via drug d marketing $325 million for marketing drug D for unapproved uses
$400 million for deceiving investors about marketing of drug D
Many former colleagues are excited about the expansion of CME into Maintaining Certification (MOC) requirements. The part that bothers me is the lack of awareness of the degree of industry influence in the development of continuing medical education.
The influence of industry is rampant and not often transparent.
The amount of money generated by commercial support of continuing medical education is problematic and often not transparent. If I had a shiny penny for every time I sat in a collaborative meeting discussing the actual, data supported needs for education that would never see the light of day--"you are absolutely right and these findings are compelling but who would pay for it?"
Obviously there are no immediate answers for navigating the complex clinical literature and evidence gathering distorted by a variety of stakeholders. But we can certainly improve our numeracy, ask better questions, and start questioning the answers.
Kendra Lawrence, RN, BSN,MHLP student presented at Lown Conference in Chicago. Here are a few findings from her presentation, Accessing Unpublished Clinical Trials: How to Obtain the Hidden Data and What if Reveals.
•Outcome reporting assessed in nearly 10,000 trials that contributed to nearly 300 systematic reviews:
•Primary harm outcome inadequately reported in 76% of trials (705/931) that comprise 92 systematic reviews
•Primary harm outcome not reported in 47% (4159/8837) trials that comprise 230 systematic reviews
•Reporting of data on harms likely less complete than reporting on efficacy
So what is a [insert your role] to do? Where is the evidence?
Join the conversation. We are going to talk about the data, learn how to access clinical study reports, and most importantly--critically assess the quality of the data informing decisions at the point of care.
(CAPRIE trial for clopidogrel was originally 8805 pages--journal article?--11 pages)
Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems...
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”