Medical education: July 2008 Archives
Do college premeds really need a second semester of organic chemistry? That's the question asked and answered by Jules Dienstag, MD, in this week's issue of the NEJM. Dienstag argues that the longstanding premed requirements of 1 year of biology, 2 years of chemistry (including 1 year of organic chemistry), and 1 year of physics "fail to...prepare students for tackling the sciences fundamental to medicine at the advanced molecular level." He continues, "We should expect a higher standard from students who wish to pursue medicine in an era in which genomics and informatics will revolutionize biomedical science and health care."
Dienstag argues for premed science requirements that are more relevant to today's medicine, as opposed to teaching the principles of 19th-century chemistry (as my orgo professor mused more than 20 years ago) to budding doctors. Instead of a second round of orgo,* go right into introductory biochem, he proposes—introducing molecular reactions that are actually relevant to bodily function and the manifestation of disease.
Dienstag also urges the integration of traditionally compartmentalized disciplines, like physiology, anatomy, and genetics, to foster a holistic approach to health and disease. And he rightly emphasizes a foundation in writing and communications skills. On this subject, I would stress a full semester of basic grammar and style (even if it's a bloody review), perhaps focusing on medical and scientific communications. Having been on the receiving end of medical manuscripts, I've noted these skills to be embarrassingly poor in too many established, academically based physicians.
* Not once do I recall the benefit in medical practice of knowing the Grignard reaction, and I was one of those freaks who liked organic chemistry.
Image of formation of Grignard reagent from Wikipedia.
that Pfizer withdrew its direct commercial support of MECC-sponsored CME because MECCs―unlike other CME-producing organizations―receive most of their income from industry-funded CME. The argument is that, because MECCs are so dependent on industry for their existence, they are more likely to bias their CME to curry favor and foster continued business with the industry grantor.
However, this explanation ignores the fact that pharma income of other CME-producing organizations, like medical societies, is not inconsequential, despite what Dr. Carlat alleges. For instance, by examining the ACCME's 2006 Annual Report (the same report that Dr. Carlat references), it is apparent that the collective, net commercial income (total commercial support – total expense) for nonprofit organizations (eg, a physician membership organization) was actually higher than that for publishing/education companies in 2006: $247,782,325 vs $210,811,540. And the average net income per nonprofit organization (n = 267) was not that far behind the net income per publishing/education company (n = 154): $928,024 vs $1,368,906.
|
Organization Type |
2006 |
Average Net Income |
|
Government or military |
-935,343 |
-58,459 |
|
Hospital/health care |
-287,209 |
-3088 |
|
Insurance company/ |
-4,308,420 |
-307,744 |
|
Nonprofit, other |
26,122,848 |
768,319 |
|
Nonprofit (eg, MD organization) |
247,782,325 |
928,024 |
|
Not classified (n = 29) |
12,946,920 |
446,446 |
|
Publishing/education company |
210,811,540 |
1,368,906 |
|
School of medicine (n = 122) |
71,740,237 |
588,035 |
So while Dr. Carlat argues that loss of pharma CME income for a big-budget academic medical center would "cause barely a hiccup," this is not likely the case for a medical society operating on much smaller revenues. For instance, the 2006 expenses of the American Academy of Neurology, the flagship organization of practicing neurologists, totaled approximately $3.5 million.
Pfizer's move to cut off MECCs, I would argue, is primarily (if not solely) based on the perception of bias in MECC-generated CME, not actual bias.* Otherwise, according to Dr. Carlat's argument, Pfizer would have considered cutting off direct CME grants to medical societies as well―a questionable PR move.
ACCME = Accreditation Council for Continuing Medical Education; MECC = medical education communications company.
* And if bias did exist in Pfizer-funded CME, it's only because Pfizer expected (even demanded) bias.
As many a blog is reporting this morning (eg, WSJ Health Blog), the Massachusetts House will vote today on a proposed pharma-code bill for the state. The vote follows yesterday's honing of the proposed legislation, which led to the removal of 1) a ban on gifts and meals to physicians; 2) the reporting of physician payments for consulting and speaking, and 3) a $5000 fine per violation. The Massachusetts Senate had unanimously passed a previous version of the bill that had included the removed items.
According to the Boston Globe, the bill will require that pharma adopt a marketing code of conduct, like the one PhRMA unveiled last week, which eliminates drug-branded tchotchkes, other noneducational gifts, and anything more than pizza or sandwiches during working hours.
Unlike the PhRMA code, however, the Massachusetts bill bans pharma's purchase and use of drug-prescribing information. New Hampshire's attempt to limit the use of these data by drug companies was judged last year to be an unconstitutional violation of commercial free speech. The AMA currently offers an opt-out program to physicians, which contractually obligates pharma from sharing their prescribing information with reps.
July 17 update: The Massachusetts House unanimously approved the watered-down bill, according to today's Boston Globe. But the House voted to delay the effective date of the part of the bill that bars the purchase by pharma of prescription info (to November 2009), while New Hampshire wrestles with the issue of commercial free speech. The differences between the bill passed in the Senate and the bill passed in the House will probably be reconciled before the end of the month, the paper writes.
