September 4, 2008

Doctors May Only Be Paid Once

The ACCME (the people who run CMEs) are asking doctors to comment on their proposal, which is:

Persons paid to create, or present, promotional materialson behalf of commercial interests cannot control the content of accredited continuing medical education on that same content.
In other words, if you're a doctor that is on Abbott's speaker's bureau for Depakote, you would not be allowed to present CME lectures on Depakote's use in bipolar, because even though CMEs are technically free of Pharma influence, you may have a bias because of your prior financial entanglements.

How could anyone be against this proposal?

Here goes...

The logic is important and deceptive.  They aren't implying that in order to keep Abbott happy, you'll lie during a CME lecture and say Depakote is more awesome than it is.

They are saying that the bias is deeper, that because Abbott pays you so much, you're going to actually believe Depakote is awesome, and you'll say that during a CME.  People will think you're being all scientific, they won't realize that the reason you believe it is because you were paid so much, so often, that you now do believe it.

So the two have to be separated.  To keep CMEs pure, speakers can't have been paid by Pharma on a similar topic.

Ok, I have a question: if we do this, why would anyone, ever, choose to do CME lectures over a Pharma talk? 

Before you freak out "not all doctors can be bought!" follow the logic here.

You aren't lying-- you actually believe Depakote is awesome.   If you actually believe Depakote is awesome, why wouldn't you only speak for Abbott and never do CMEs?  You're being honest, you're saying what you think, what do you care if people are slightly suspiscious because the dinner is sponosred by Abbott?  You're telling them what you know to be true.

Take it a step further: what if you believe Depakote is awesome based on science, or your own judgment?  And had never been paid by Pharma before?

Then you see, the result of this inanity is that anyone who believes, for any reason, Depakote is awesome will have to choose between giving a few CMEs a year for less money, or lots of Pharma programs for more money.

I observe that there's no prohibition on receiveing NIH money and giving CMEs, because obviously there are no biases at the NIH.

Look, people, if you want to completely ban doctors from ever doing Pharma programs, then let's take the debate there and decide.   But if you cannot construct a solid argument for this abolition, then all of this back door, smoke and mirrors protectionism will always follow the law of unintended consequences.

(Another post  on the separation of church and state.)