“When you have a totally sales-motivated reason for doing CME, you should consider other options.”

The return on investment for CME should be measured more in terms of improving public health than increasing script sales, asserted panelist Mark Deitch during the Pharmaceutical Alliance for CME section meeting at the Alliance for CME's annual conference in January. How does Deitch convince his clients of the value of CME? For one thing, when Deitch, a 20-year medical education veteran, founded New York-based Bio/Science Communications, a medical education and publishing company in 1995, he made a strategic decision not to seek accreditation — out of his respect for CME. An interesting decision, particularly in light of the recent controversy over whether or not for-profit medical education companies should even be eligible for accreditation.

Q: Why did you decide not to become accredited?

A: I find odd the idea of for-profit medical education companies being accredited. It seems a little like the fox guarding the henhouse. I want to work with the best medical universities and associations, including the National Institutes of Health, to do CME for our clients rather than sell our own branded CME.

Q: Would you expand on your comment that some product managers use CME to advance product messages?

A: I have a great deal of sympathy for the pressures on teams bringing product to market these days. I was at a major pharmaceutical company about a month ago, talking to the new product team. After six years, the first product had reached phase one [in the FDA approval process]. They spent six years working on development compounds that never made it. That graphically [illustrates] how much pressure there is to make a compound work.

As a result, there is a growing tendency to want to micromanage CME events, not so much to fudge corners or to fudge data, but to make sure everything is controlled, that the speaker doesn't say anything the supporter wasn't prepared for. That is unfortunate in terms of open scientific symposia. In the most extreme cases, I've also seen a tendency toward not only trying to represent studies or product information in the most favorable light, but trying to find or develop data that puts competitors in the worst light and to get that information in CME events.

Q: How do you explain the importance of independent CME to commercial supporters?

A: We see our job as a constant education process as to what one can and can't do in CME and why. We explain in advance so that all parties can adjust and rethink their position. When you have a totally sales-motivated reason for doing CME, perhaps you should consider other appropriate options, such as in-label promotional events.

Q: At the PACME session, you commented that one aspect of CME's ROI is the effect on public health. How do you define CME's ROI to industry clients?

A: I find it hard to answer questions like what is the ROI in terms of sales — are scripts going to rise, will people walk out with a more positive view of our product. That's why at the PACME meeting I tried to shift the argument and talk about ROI [in terms of] overall public health. Ultimately, that is the bottom line. We're in this field to advance the knowledge and use of therapies to improve public health.

I sometimes ask, What would happen if you didn't do the program? There are some very worthwhile products that are no longer available because there wasn't sufficient education about them. We have a certain amount of responsibility, as members of the medical community, to bring forward information on scientific advances. We have a moral and financial obligation to do this. Otherwise, something good can be lost. In a way CME is the price of admission, of correctly informing the community and marketing the product.

There's a larger issue of changing practice. Are we content to stay on the peripheries and deal with fuzzy issues of awareness and influence and when influence is good or bad — or are we going to get into the real issue of changing practice? Should our educational functions remain one step removed, with dispassionate discussion of information, or should we be activist and literally try to change practice? I think when we set our sights on ROI as the bigger picture of improving patient health, there is a rationale for CME to be activist.