Different Kind of CME Needed

The March 1 issue carried a report on a Lilly-funded study comparing fluoxetine, paroxetine, and sertraline. The conclusion was that these three “best-selling SSRIs are nearly indistinguishable as first-line treatments of depression in primary care.” The outcome “surprised” the primary care physicians involved.

Sadly, this “surprise” reflects our vulnerability to the well-crafted advertising efforts of the pharmaceutical industry. Many writers have noted the incredible skill and sophistication of the advertising business, whether it is selling political candidates or beer or soap. It is no surprise that medicine and doctors fall prey to these skills.

As physicians we are shown glossy, well-designed charts and presentations depicting the “clear” advantages of one medication over the others. This information is presented by skilled and often pleasant drug representatives who often offer food along with their message. Perhaps even more insidious is the article or “free” CME insert on “treatment of bipolar disorder” and so on. In these “unrestricted” educational presentations, there is often a not-too-subtle bias toward a particular medication featured by the pharmaceutical underwriter. We are led to believe that the data are objective, and “statistics” don’t lie. We know, however, that in the presentation of data and statistical information there is considerable room for crafting the presentation and selecting data to “prove” a point. One needs to be well versed in statistical analysis and experimental-design analysis to truly decipher the glossy presentations. Most of us lack these high-level skills.

What we need is the introduction of seminars in numerous CME venues focusing on the understanding and analysis of the pharmaceutical/pharmacological “information” flooding our professional lives. Perhaps these should be mandated in the same way that risk management CME credits are required. The role of advertising in psychiatric practice is not going to change except to become more intrusive and pervasive. We need to be trained more effectively to understand it and protect our practice of medicine.