Wyeth and University of Wisconsin sitting in a tree…

…..selling us their CME!

Wyeth is coming under increasing scrutiny for its incestuous relationship to academic medicine. First, it was discovered that the company contracted for ghost written articles that appeared in mainstream medical journals under big name academic authors.

Now the Milwaukee-Wisconsin Journal Sentinal reports that in the year following the Women’s Health Initiative, Wyeth invested 12 million dollars in a CME program targeting docs who prescribe HRT – a program that the Journal Sentinal reporters claim downplayed the risks and highlighted the benefits of the treatment. Administered through the University of Wisconsin and written almost entirely by Wyeth’s ghost writers at Design Write, the course netted over a million dollars to the university, not including money paid to consultants involved with the course.

The Council on Hormone Education – A Wyeth front group

Wyeth delivered it’s message under the guise of a group they created called The Council on Hormone Education – a consortium whose members were Wyeth, Design Write, the University of Wisconsin, Wyeth’s paid consultants and a smattering of unpaid academics whose point of view on HRT coincided with the group’s agenda. Together the group produced and distributed over 16 newsletters and maintained a website that only recently came down the day after the Sentinal published it’s investigative report. A quick google search finds position statements on HRT from the group sprinkled throughout the web.

As a member of Wyeth’s target audience, I’ve received pretty much all of the material from this program either via mail or online at various venues since 2002. I recall checking into the Council early on and figuring their were a Wyeth front group, and learned to take anything from them with a grain of healthy skepticism.

Is Wyeth the Bad Guy?

The information Wyeth disseminated was technically correct. It just tended to highlight the benefits of HRT, which are real, as opposed to the risks, which are also real. They made sure everyone heard the latest theories that HRT started early on was safer than HRT started later, giving a legitimacy to a theory that, while plausible, has yet to be supported by any randomized clinical trials. They publicized the results of the estrogen-only arm of the WHI, data the media pretty much ignored compared to their reporting on the Prempro combination data.

Wyeth will argue that their message was scientifically-based and necessary to balance out the anti-HRT hysteria perpetrated by the release of the WHI results. That someone needed to point out the flaws of that trial, which failed to enroll women with menopausal symptoms and whose population was a good decade older than the typical new start HRT patient. They will say that their message is much more scientifically based than the mythology perpetrated by the anti-aging crowd, who seem to be getting away with saying anything they want to the American Public without any scrutiny from Congress. That they are being singled out among the field of Big Pharma, whose members all play from the same playbook.

Some of these arguments, if they make them, may even seem defensible. But none of that justifies the use of a front group to take Wyeth’s message to physicians for them. None of it justifies the kind of stealth marketing disguised as CME that has taken over graduate medical education. Or the gostwriting.And none of it justifies playing down the risks of a therapy they are selling.

But truth be told, it’s not Wyeth that I’m upset with. I’ve come to expect this kind of behavior from Big Pharma. After all, they have a product to sell. I should expect a sales pitch from them.

In fact, Wyeth isn’t the only pharmaceutical company using the University of Wisconsin to get CME. Pfizer, Bayer and others have joined forces to create and market CME related to their products as well.

Or are we physicians to blame?

No, it’s academic medicine that so disappoints me. The bed we are sharing with Big Pharma is king sized, and big enough for all of us. The University of Wisconsin may be the biggest player, but we’ve all played our part in creating this monster called Pharma-sponsored CME.

We’ve taken their money for paid consultancies. We’ve given and listened to their canned slide show CME lectures because it’s easier than creating them ourselves in the shrinkingly small blocks of protected time academic medicine allows these days. We eat their lunches and go to their sponsored dinners and attend their lectures at medical meetings. We visit the Hall of Wonders at our meetings and stash our cloth satchels with free pens, power bars, flashlights and other trinkets to take home to our kids. We read the throwaways instead of the scientific journals because they’re glossy and faster to read. We have their TV’s and their magazines in our waiting rooms. We visit the internet sites for pharma sponsored CME to fulfill our increasingly CME-laden licensing requirements (and I’m starting to wonder how CME got all mixed up with licensing, now there’s something to investigate…)

Now what do we do?

It’s really time to start to sever the ties. How?

If you’re giving a talk, skip the prepackaged slide sets and make your own. (I have to admit I’ve taken more than a few slides over the years from the free teaching sets offered by some of my medical organizations that were clearly Pharma sponsored CME.)

Look for CME sources in the peer reviewed journals, like the NEJM or see what’s being offered for Pharma Free CME at Pharmed Out. If you see a “sponsored by an unrestricted grant” at the bottom of CME, go find something else to read. If you’re at a medical meeting, skip the box lunch seminars and the Hall of Wonders – go instead for a work out or tour the town you’re visiting. Or read a textbook.

Some of our smaller medical groups are starting to experiment with Pharma free CME. What I can’t understand is why our medical organizations aren’t setting the example by setting up Pharma-free meetings. I don’t expect anything anytime soon from the AMA , but c’mon NAMS or ACOG, how ’bout it?
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Pharma-Free CME at Pharmed Out