Two themes this week. First, on the very same morning I sent out last week’s Health Tip expressing my dismay at an Annals of Internal Medicine article and editorial advising physicians to discourage patients from using multiple vitamins a new study from Germany showed that vitamin D deficiency was strongly linked to fatal heart attacks and strokes.
Typical multivitamins, like Centrum Silver or One-A-Day, contain small amounts of vitamins, called “minimum wage” vitamins by nutritionists, but the minimal amount of vitamin D in each of them (800 IU or 200% of the minimal daily requirement in Centrum Silver, 1,000 IU or 250% in One-A-Day Women’s 50+ Healthy Advantage) is, according to the study, enough to confer some heart protection. The article shows that vitamin D deficiency increases risk. At WholeHealth Chicago, we measure vitamin D levels and discover that virtually everyone not taking supplemental D is deficient, some with amazingly low levels.
My day didn’t get better when I read a brief report in this week’s JAMA (Journal of the American Medical Association).
Doctors and Big Pharma under the microscope
The relationship between physicians and Big Pharma is receiving ever more scrutiny. In this article, researchers from Columbia University wanted to explore the questionable relationship between Big Pharma and an industry you’ve probably never heard of called Medical Communication Companies (MCCs). You’ll likely recognize the biggest MCC players–familiar internet names like Medscape and webMD–but there are numerous others, accessible only by physicians, with distinguished-sounding names like Postgraduate Institute for Medicine, Network for Continuing Medical Education, and Institute for Medical Education and Research.
By way of background, you already know that physicians do try to keep current with the latest developments in medicine. At one time we achieved this by subscribing to an assortment of print journals and attending meetings with other physicians in our field. And while the journals were replete with Big Pharma ads and the meetings always had one convention hall filled with Big Pharma displays, at least the articles you’d read and the lectures you’d attend were free from commercial taint.
As a physician, you also need to prove to your local state licensing board that you’re keeping abreast in medicine by accumulating Continuing Medical Education credits (CMEs) each year. With the journals, you’d complete a quiz on the back page, mail it in, and receive a certificate stating the number of hours you’d earned by reading that issue. At medical meetings, you’d sign in at the beginning of every lecture and a couple of weeks later receive a certificate from the meeting’s sponsor, almost always a not-for-profit medical group (like the AMA or Chicago Medical Society) or a medical school.
Although educational programs like these are still available, with the decline of paper and ink, rising travel costs, and the financial strain on a doctor leaving her practice for a week or so, there’s far more reliance today on online medical education to accumulate CMEs.
Which raises a serious problem.
For-profit continuing medical education
According to the JAMA report, the bulk of CME courses are being offered under the auspices of MCCs, a majority of which are for-profit entities receiving most of their funding from (who would have guessed it?) Big Pharma.
What kind of money do these MCCs actually receive? Well, the total grant money from the top 14 pharmaceutical companies (for both education and research) in 2010 was $657 million. Of this largesse, 26% ($170 million) went to MCCs specifically to “educate and communicate with” physicians. Smaller grants were distributed to academic medical centers, disease-targeted advocacy groups, and professional medical organizations, like the AMA.
Medscape/WebMD, a single company, is a mega-source of physician CME credits. (The WebMD portion provides health information to the general public that virtually always recommends using a Big Pharma product to cure what ails you.) It received $20 million in Big Pharma grants. So-called disease-targeted advocacy groups are usually a cover for Big Pharma commercials. Google “fibromyalgia” and two of the three top results are sponsored by Big Pharma. Now try this with virtually any medical condition.
With physician education and CME accreditation moving online, the bulk of CME courses are now under the auspices of MCCs, which in turn are funded by Big Pharma. What this generally means is that an innocent-sounding useful course called “Advances in Diabetes Management” may mysteriously have as the correct quiz answers (the answers that will earn you CME credit) those that promote pharmaceuticals.
Interestingly, the CME cannot name a specific drug brand because that would be a “conflict of interest.” But mentioning the same drug’s chemical name is completely allowable.
Your doctor’s class on migraines, sponsored by…
For example, I might take a CME course on migraine headaches, sponsored by Zogenix, maker of a new migraine treatment called Sumavel. Because I’m required to enter so much personal and practice data just to enroll as a Medscape physician, the MCC can collect this information, share it with Big Pharma, and sell it to Little Pharma–fledgling pharmaceutical companies (there are dozens) itching to get their hands on physician data.
The MCC will also track my interaction at its website, scrutinizing the topics I’m seeking information about so they can send some targeted marketing in my direction. If I look up migraines on Medscape, I’m bound to start receiving “informative articles” and, if they do develop a CME course, I’ll be reminded to sign up.
Big Pharma can also buy data from Walgreen’s to track my prescribing behavior and see if these MCC investments are actually paying off. The CME course–written by medical writers, almost never by physicians–will allegedly teach me something about migraines, but mainly about drugs, primarily about the “positive studies” submitted to the FDA (hiding away the negative ones) that merited FDA approval. There will probably be some subtle language that trashes the drug’s competitor, such as a list of side effects.
I’ll then get CME credit, which I can use toward renewing my license. For the following few weeks, I’ll receive an increased number of articles online updating me on the latest advances in migraines (with emphasis on drug treatment) with lot of little Sumavel icons across the top. I may even get a visit from my Sumavel rep. (You’ll recognize this tracking behavior if you’ve ever shopped online and subsequently started seeing copious ads for precisely what you were shopping for.)
Is this all worthwhile to the Pharma company? You bet it is. Sumavel may or may not relieve your migraine, but it costs $125 a dose, a single prescription providing six doses, or $750 a pop.
Let me end this cheery health tip on Big Pharma mind control with a long-forgotten science fiction story I once read. It had the following very spooky premise: Silicon (sand), the very heart of every computer on the planet, was actually a living substance and the alien force that had animated silicon was waiting until every human on the planet had access to a computer. Then, in a single moment, all our brains would collectively be controlled by the silicon in the very computer you’re now using to read this Health Tip.
But that’s the stuff of science fiction. You don’t have to worry. It’s only your doctor whose brain is being controlled. All you need to do to protect yourself from her is to stay…very healthy.
David Edelberg, MD