Why Doctors, Like Airline Pilots, Should Not Be Completely Trusted.  Reply

I would never get on an airplane if I didn’t feel highly confident that the pilot was fully competent. In order to fly a commercial airplane a pilot has to  undergo rigorous and continuous training and testing. I’d walk before flying with a pilot whose only credential was his assurance that he’d been diligently “keeping up with his field” and that he was extremely confident in his abilities. I’m glad to know that the FAA and the airlines have extremely demanding programs to ensure the competency of pilots.

I would trust 99% of pilots to remain competent on their own. But when it comes to flying 99%” isn’t good enough. We need to know, within the bounds of what is reasonable, that all pilots are competent. Unfortunately, because of the few bad ones, the remaining 99% have to undergo all the rigorous training and tests.

Doctors are like pilots: what they do is far too important to let them individually decide for themselves whether they are competent, or how they should demonstrate their competency. Just because the vast majority of pilots and doctors are competent doesn’t mean that we should loosen our standards.

This topic is important now because of a current red-hot debate over what physicians have to do during their career to maintain their certification– called maintenance of certification, or MOC…

Click here to read the full post on Forbes.

 

Three Reasons Why You Don’t Need To Feel Sorry For Doctors Reply

I’m not a doctor and I don’t have strong opinions about how doctors should be certified or, more to the point right now, what they should have to do to maintain their certification over the course of their careers. But recently this last topic– called maintenance of certification, or MOC– has become the subject of a raging debate within the medical community, as thousands of doctors have expressed their displeasure, to put it mildly, with a new recertification scheme established last year by the American Board of Internal Medicine, the official “certifying” body of a large proportion of doctors in the US. From what I’ve read it appears that the critics of the new system have some very legitimate points and that some big changes will likely be necessary. But in the course of the debate I have been disturbed by some of the arguments that have been used to criticize the new MOC. (Unfortunately I haven’t seen a lot of attempts to actually defend the new scheme so I can’t give equal time to the other viewpoint.)

Click here to read the full post on Forbes.

 

Continuing Medical Education Payments To Physicians Will Be Exposed To Sunshine Reply

After a long and complicated struggle it now appears highly likely that industry will be required to disclose payments to physicians for continuing medical education (CME). This decision from CMS, which I am told by reliable sources is final, follows a long period in which CMS appeared to waver in its approach to incorporating CME into the Sunshine Act.

Click here to read the full post on Forbes.

 

A CME Program Begs The Question: Promotion Or Education? Reply

In recent years defenders of commercially-supported continuing medical education (CME) have claimed that the industry has cleaned up its act and that CME programs today are largely free of the abuses that were so common not so long ago. Perhaps. But there are still plenty of examples of programs that violate the fundamental principle that medical education should be completely separate from commercial interests.

A striking example is a recent email I received from TCTMD, the online arm of the Cardiovascular Research Foundation (CRF), which is basically the equivalent of the Vatican for interventional cardiologists. The subject line of the email was nothing out of the ordinary:

Sponsored Message from Volcano: ADAPT-DES Webcast and Investigator Interview

I get lots of these sort of messages from different medical organizations. I’m not crazy about them but I understand that these groups have to pay their bills. But it’s vitally important that these groups maintain a clear separation between commercial messages like these and genuine educational content.

The text of the email makes some astonishing claims. It makes the case– not surprising in a promotional message– that interventional cardiologists should use IVUS more often during their procedures. But the text fails to mention that the numbers mentioned in the text come not from a randomized controlled trial but from an observational study. The findings thus should be considered hypothesis generating. In addition, as is so often the case when medical results are being hyped, the relative differences sound quite impressive– 50% reduction in stent thrombosis and 33% reduction in MI– but the absolute differences are much less impressive: at one year stent thrombosis was reduced from 1.04% to  0.52% and MI was reduced from 3.7% to 2.5%. And remember, since these differences are not the result of a randomized comparison they may be completely illusory.

Click here to read the full post on Forbes.

 

 

No Sunshine For Continuing Medical Education 1

After many long delays, CMS today released the final details of the Sunshine Act. Starting next September all pharmaceutical and device companies will be required to publicly report payments made to US physicians.

 

However, there is at least one very major exception to this requirement. Although the initial draft of the rules stated that payments made, directly or indirectly, to physicians speaking at continuing medical education (CME) programs would need to be reported, this part of the rule has now been substantially weakened. According to the final rule, companies will not be required to report payments to speakers at accredited CME events as long as the companies don’t select the speakers or directly pay them. In other words, accredited third party CME providers will be entirely exempt from reporting payments to speakers.

 

Click here to read the full story on Forbes.

 

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