Are CME providers being used by the pharmaceutical industry to legitimize a treatment for conditions that aren't really diseases? Did Glaxo SmithKline “invent” irritable bowel syndrome in part by underwriting CME on the subject? These uncomfortable questions have been raised in an article in the April 13 issue of BMJ (formerly known as the British Medical Journal).

In “Selling Sickness: The Pharmaceutical Industry and Disease Mongering,” authors Ray Moynihan, a journalist with the Australian Financial Review; Iona Heath, a London-based general practitioner; and David Henry, professor of clinical pharmacology, School of Medical Practice and Population Health, University of New Castle, Australia, charge that drug firms are “widening the boundaries of treatable illness in order to expand markets.…Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers.…Because these ‘disease awareness’ campaigns are commonly linked to companies' marketing strategies, they operate to expand markets for new pharmaceutical products.”

Since building awareness of “underdiagnosed and under-treated problems” sounds a lot like CME, we asked members of the CME community to comment on the story. Of the CME providers who responded to our query, only Michael Altmann, executive vice president of BESTMED, a unit of Saatchi & Saatchi Healthcare Resources in New York City, thinks the authors might have a point. “While I have no direct experience in this particular initiative, I would look into the ‘disease’ of overactive bladder. Its appearance seems coincidental with the introduction of various products to treat it,” he says.

Other respondents are more dismissive. Michael Kessler, MD, president of the Medical Communications Center Inc., an Atlanta-based firm that trains pharmaceutical sales reps, says, “I think that…disease state CME [is] only helping the health care delivery system.” He cites erectile dysfunction as an example. “By diagnosing ED, we are…intervening earlier in the diagnosis and treatment of peripheral vascular disease,” he says. “There are 20 examples like this for every one that may seem specious.”

Noting that neither England nor Australia has a system that regulates CME's independence as does the U.S., Frederic S. Wilson, manager of CME for Procter & Gamble Pharmaceuticals, Mason, Ohio, questioned whether the BMJ article had any relevance for U.S. CME providers. He also emphasized that “Pharmaceutical manufacturers have an ethical obligation to be the most knowledgeable about their products and to convey that information to health care providers…through financial support of independent CME.”

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