When Doctors' Education Is The Best That Pharma Money Can Buy- Part 2
In part 1 I talked about information that was brought to me by two senior residents who wanted people to know that they are being invited to “educational summits” that are actually being run by doctors with massive undisclosed ties to the pharmaceutical companies that make the drugs that are recommended in the summits. I did some digging around the company that is behind this to try to get some information about what’s going on.
The company that created both of these summits is PCMG, Primary Care Metabolic Group. Their tagline is “Serving to Educate Primary Care Clinicians on Metabolic Issues.” The words “Evidence Based Medicine” appear prominently in the banner at the top of each page. Their homepage states:
The Primary Care Metabolic Group (PCMG) is a national educational initiative providing comprehensive metabolic disease resources. PCMG’s mission is to provide an easily accessible repository of metabolic disease information for primary care clinicians that includes disease management and raising standards of patient care through the dissemination of best practices and educational information.
Their ”services” include
· Monthly metabolic disease news articles from our partners
· Opportunities for FREE CME
· Member discounts for upcoming CME conferences and summits
As a quick aside, CME stands for Continuing Medical Education. Doctors must obtain a certain number of CMEs in order to maintain their state licensure. The number of CME hours and requirements as to topics varies by state. Full disclosure, many of the workshops/talks I give for physicians provide CMEs. None, as far as I know, has ever been sponsored by a pharmaceutical company and I don’t receive any money from the pharmaceutical industry.
Back to PCMG. The word “partners” struck me in the first bullet point. What do they mean by “partners?” As I scrolled down the page I see that they are welcoming a new “collaborator” – the Ob*sity Action Coalition. It says “This national nonprofit coalition is fighting to eliminate weight bias and discrimination, elevating the conversation of weight and its impacts on health, and offering a community of support to people affected. OAC also offers resources for clinicians, as well as a database of clinicians who treat patients with ob*sity.”
It doesn’t say that this “national nonprofit coalition” has Novo Nordisk (manufacturer of the weight loss drug Wegovy and one of the leading pharma companies price gouging on insulin) as its main funder, with the vast majority of its funding coming from pharmaceutical companies and weight loss surgery interests. It doesn’t say that their plan to “eliminate weight bias” is focused on pushing for insurance coverage of their dangerous drugs and surgeries, or that they are trying to sell the “we don’t want to stigmatize fat people, we just want to make as much money as we can trying to eradicate them from the earth” line that is not, in any way, an anti-stigma approach.
After reading the entire website, I called PCMG to ask what they meant by “partners” as well as who was funding the free and discounted CME training.
I spoke with Nora Williams. I opened by explaining that I was writing an article about CME trainings and I had a couple quick questions about how their trainings were structured. She interrupted me to say that she was “suspicious” because she didn’t know who I was, or what outlet I was writing for, or what my story was about (in my defense, she hadn’t let me get that far.) She told me that if I sent her an email she would “consider it.” For me, this has the ring of a company that knows they are involved in things that they would rather not have brought to light, but of course, that’s just my gut feeling. I emailed her after our call in the afternoon of 1/7/23 and am still awaiting a response.
However, the email that she gave me led me to PCEConsortium.org
In searching, I had already found Primary Care Respiratory Group – US (PCRG) which has a website that is almost an exact copy of PCMG, except replacing metabolic with respiratory. The Consortium site has a long list of free CME workshops.
I wanted to look into their materials, so I started by downloading their free CME “Common Questions on Continuous Glucose Monitoring (CGM) in Primary Care” I am not an expert in CGM, but I do a lot of work around weight-neutral blood sugar management and so it’s an area where I felt confident that I had enough knowledge to understand the paper.
The author is Eden Miller, DO (who you may recognize as having been a speaker at both the free summits and having taken $1,429,227.40 in industry payments.) Miller is the co-founder and CEO of Diabetes Nation - Diabetes and Ob*sity Care, and in this publication disclosed that she serves on the advisory board and speakers bureau for Abbott Diabetes, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk; on the advisory board for AstraZeneca, Merck, Plenity, and Sanofi Aventis; and does research for Abbott Diabetes and Pendulum Pharmaceuticals.
Here are some things that I noticed:
Two of the devices that the paper specifically mentions are made by Abbot Laboratories (for whom Miller is a speakers bureau member and does research.)
In the section “Which patients will benefit from its use” Miller (who, again, takes money from a CGM device manufacturer) writes “This author does not feel there are any poor candidates for CGM as all people with diabetes could benefit on some level from the data and insight it provides.”
That struck me as odd. Again, I’m not an expert but it would be…surprising… if this device wasn’t contraindicated for anyone. A quick search of Abbott’s website (remember this is a company for which Dr. Miller does research and is on the speakers bureau) explains that you “should not use the [CGM] system” for people less than 18 years of age, critically ill patients, pregnant women or patients on dialysis, and that the system has not been evaluated on patients who use other implanted devices. Other studies and articles mention things like technology aversion, medications that interfere with CGM, certain mental health diagnoses, patient motivation, and other contraindications.
So, there are, in fact, poor candidates for CGM. I would suggest that this is a problem whether Dr. Miller was ignorant of this or purposely left it out. Remember, this is Continuing Medical Education – doctors are supposed to be able to rely on this information in their practice, so telling them that there aren’t any poor candidates, when there very much are is a failure of that education and a danger to patients.
She did make sure to include a section called “Key elements to obtaining Medicare, Medicaid and private insurance,” complete with billing codes. She also mentions that “In a recent comparison of retail costs, Abbott’s FreeStyle Libre had the lowest monthly cost…”
The conclusion states “CGM is quickly emerging as a standard of care for many patients with diabetes.”
To back this statement up, Miller cites a study by John B. Welsh, PhD and Roy Thomas, PharmD. A quick look at the disclosures for that study finds that both are employees of Dexcom, the manufacturer of the Dexcom G6 Continuous Glucose Monitor.
You have to wonder: To what extent is this CME providing evidence-based information, and to what extent is this simply an extension of Dr. Miller’s duties as a member of Abbott’s Speakers Bureau?
But maybe this one was just a fluke, right? While I was waiting on the reply from Nora that never came, I took a quick look at some of the other free CME on the consortium’s page. I definitely found a pattern of CME that was recommending products that were part of the author’s disclosures. A couple of quick examples:
Title: Improving Detection and Management of Anemia in CKD
Authors: Steven Fishbane, MD; Stephen Brunton, MD, FAAFP
Dr. Fishbane: Consultant and does research for Akebia and AstraZenec aand is a consultant for FibroGen and GlaxoSmithKline.
Dr. Brunton: Advisory board and speakers bureau for Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, and Sanofi, and on the advisory board for Xeris and Pendulum Therapeutics.
Summary: “HIF-PHIs are investigational agents on the horizon that, if approved, will offer patients an oral option to treat anemia in CKD”
A quick search found that AstraZeneca, GlaxoSmithKline, and Akebia are all developing HIF-PHIs.
Title: The Role of Eggs in Healthy Diets
Author: Maria Luz Fernandez, PhD
Key takeaways: Eggs can be part of a healthy diet, Epidemiologic evidence and clinical trials have found no links between egg intake and increased risk for heart disease, Eggs are a good source of high-quality protein, Eggs, in addition to numerous vitamins and minerals, contain compounds including choline, lutein, and zeaxanthin with functions that go beyond nutrition as they protect against chronic disease.
Disclosure: Dr. Fernandez has a research grant from The American Egg Board.
Sponsorship: “This [CME] activity is sponsored by Primary Care Education Consortium and supported by funding from The American Egg Board.”
There is language in some of PCMG’s CMEs (though, interestingly, not in the egg-related CME) that claims that conflicts of interest have been “mitigated,” but is that even truly possible?
Regardless of how ethical the authors might be, there are undeniable conflicts of interest when those who are creating education about pharmaceuticals are also paid advocates for those pharmaceutical companies.
At some point, simply disclosing affiliations is not enough. I believe that we are, in fact, way past that point. There is literally nothing to prevent the pharmaceutical industry (not to mention weight loss surgery interests, medical device manufacturers, etc.) from simply putting a stable of doctors on their payroll and letting them use their credentials as the ultimate sales tools, including by engaging with companies that convert pharmaceutical industry marketing messages into CMEs that are delivered to doctors and other healthcare practitioners who think that they are getting education about best practices and educational information. It’s similar to what we’ve seen in the media and it is a dangerous disservice to healthcare practitioners and patients.
I want to, again, give thanks and credit to Dr. Clarissa O’Conor and Dr. Will Ward, who originally reached out to me, for all of the work they did researching this. They are in the middle of intense training and still finding the time to do extra work to try to get the education (free from pharma industry influence,) that they deserve.
And we should all have their backs - asking questions, doing research, pointing out these flagrant conflicts of interest and dirty diet industry tactics. Our doctors deserve the best education they can get, not the best education pharmaceutical companies can buy.
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Note I don’t link to everything I discuss in this post because I don’t want to give traffic and clicks to dangerous media.