More to do, more to know, more to manage

Coordinated Learning to Improve Evidence-based care: A model for Continuing Education for the New Healthcare Environment has created a much needed energized base in continuing education. On one hand, the industry as a whole is slow to respond to the evolving needs of healthcare providers outside of the watchful and financial resources of industry funded CME. On the other hand, many have debated the role of a Pharma company dictating how to evolve the CME framework. The article and framework is spearheaded by Genentech. Basically, if you hope to be funded, you will need to follow their articulated framework--drink the kool-aid so to speak--not necessarily a bad thing.

My clients seem to fall into two camps. How do I follow the model or how can I create a model beyond TELMS that addresses many of the key points? I am not going to debate the model but I will weigh in on the vagueness of "how" these mechanisms can be implemented beyond the narrow scope of the article. Let me cast a wide net and share a bit of what I find problematic regarding claims to "Improve awareness, convert information, demonstrate engagement, and substantiate partnerships". I don't have the answer--I would at least like to create an important dialogue.

Medical education as a whole is data poor. The quality of data collection and analysis by even CME industry leaders is laughable. Look. I am not trying to be confrontational or combative. Each time I post a critical review of the learning healthcare system I create a diaspora. That is all well and good. If you choose to join me in trying to make sense of what we can accomplish with strong and concise objectives, I welcome you. If you are a medical education company reporting learning outcomes, no matter how far up the food chain you think you are--I have seen your data, reports, and post-activity deliverables. Maybe not by you, but I assure you, your clients or colleagues are looking for guidance--especially when they are handed a low quality output and made to defend the spend to their finance committee.

The data is compelling, confusing, and potentially influenced by industry and financial interests on a global scale. I am going to use T2D as an example. Lately I have been working with Oncology data but there is a whole other level of complexity there.

Data on food nutrition, food policy, consensus data, and clinical patient databases are informative when discussing chronic diseases--specifically Type II Diabetes. The short audio below sets the tone from the preventative perspective. You don't need me to tell you healthcare costs are unsustainable. There are limits to out-innovating our biology. We need stronger and more robust policies upstream from disease.

Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults provides an analysis of National Health and Nutrition Examination Survey Data.

Continuing medical education laments about inviting voices outside of the bubble to the conversation about improving health outcomes through better education for providers. I agree. TELMS lacks the instructional granularity to guide toward data sources to add a full dimensional perspective on disease. A much needed guidance for healthcare providers responsible for the future outcomes of the healthcare they deliver.

The Expanded Learning Model for Systems (TELMS), offers a framework for designing, implementing, and evaluating learning solutions that move both HCPs and patients through a series of learning stages to enable them to adopt evidence-based behaviors informed by quality and performance indicators, and which will help CE stakeholders to demonstrate how such changes lead to improvements in care coordination and quality of care.

A total 360 degree look at care must include the cost and financial perspectives. The new administration has hinted at allowing cost to become part of care considerations. You will need to learn how to follow the dollar. Commercial companies typically follow the lead of Centers for Medicare and Medicaid.

Many times we write about available interventions focused specifically on mechanism of action and potentially side-effect profiles--especially if those might be differentiators. If you rely on clinical literature, you will need to turn a keen eye on competitors selected in clinical trials. Will Cardiovascular Outcomes Data on Newer Diabetes Drugs Bury the Older Agents? is a timely article in JAMA Internal Medicine.

Although the FDA has traditionally focused on the safety and efficacy of drugs relative to placebo, there are abundant good reasons for the agency to push industry and other study sponsors to use active controls in type 2 diabetes studies. The major clinical role of the new drugs is as alternative treatments, not as therapies for patients who otherwise would not be treated with drugs.

 I also like to look at Investor Reports accessible on the internet. We hear about "Innovation" being stifled if we lower drug costs.

Shouldn't the drug pipeline show investments in innovation? How about record amounts of shareholder dividends or stock buy backs? When you neglect to look at data and understand the "patient/return on investment" of shareholder argument you become a PR machine--not an informed voice or part of the broader discussion of change in healthcare.

What if I told you that many companies create revenue by cycling profits back to shareholders instead of capital investments like R&D? Obviously pharmaceutical companies are heterogeneous and have different practices and incentives but the demand for greater transparency is a bit ill-informed and ignorant. They are already transparent--If you know where to look.

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I highlight Novo-Nordisk only because Victoza tops the list in physician renumeration. It also tops a few other lists if you investigate quarterly trends in FDA Adverse Event Database (FAERS) data reported by Druginformer.

-The industry affiliated model, TELMS highlights the cognitive overload of 27000 articles published every week but neglects the role of industry or low quality and poor statistical design of the large majority. Many decisions at the point of care are incentivized based on dubious claims or over-medicalization. We could do more by empowering providers with tools to improve numeracy.

Here is a brief snapshot of industry influence from a Virtual Expert Roundtable where a panel of experts will "discuss strategies to set appropriate HbA1c targets, how to select guideline-based therapies, and how to engage and motivate patients to be fully invested in their treatment program to reach their HbA1c goals."

​Here are the industry payments to expert #1:

The website Open Payment Data reported $272,023.63 in total general payments.

Industry payments to expert #2:

Open Payment Data reported $118,498.46 total in general payments.

Industry payment to expert #3:
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Open Payment Data reported $96,317.25 total in general payments. I am not here to demonize anyone but an educational program where the 3 "experts" are being paid ~ half of a million dollars by industry--is not trivial. 

Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries  demonstrates an association (not causal) with increased brand-name prescribing following industry-sponsored meals. 

Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management is an article describing social correlates of health. Discussions of basic resource needs as an interventional strategy are effective in directing care.

Intensive Treatment and Severe Hypoglycemia Among Adults With Type 2 Diabetes helps to demonstrate the benefits or limits of treatment intensification in patients that do not benefit. The risk of hypoglycemia almost doubles in highly clinically complex patients.

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Join us at the Medical Affairs and Scientific Communications Forum. I will discuss "Data Talks, People Mumble"--new ways of presenting data in healthcare and medicine.