CMEs and purple light — what are doctors and nurses learning?

Once one becomes a nurse or a doctor, it is now possible to get the continuing medical education credit hours required to keep our licenses without ever reading a lick of science. That’s a terrifying thought as a patient and a disheartening one as a medical professional.

For years, professionals have been lamenting the growing pseudoscience and alternative modalities in university curriculums, including medical school and nursing programs. The latest list of continuing educational courses for nurses to maintain their professional licenses, accredited by our state nursing association for this quarter, was just issued. Once again, it was replete with unscientific woo, such as courses in alternative medicine, reiki (8.4 credit hours), Chi Nie Tsang (21 credit hours), energy medicine (35.8 credit hours) and homeopathy (7.6 credit hours). Chi Nei Tsang, nurses are taught, is a deep organ massage that purportedly heals by working “on internal dysfunctions and energy blocks” and includes a variety of energy techniques. A certification in purple light is also offered by the provider which, it explains, will “strengthen the pure alchemical and conscious evolutionary practices using Ancient Taoist modalities as a bridge to connect all lineages, and bring ancient teachings into present day situations. As the earth moves through her evolution, lineage traditions must come forward to clarify and share their understanding of the human experience.”

Yikes. If my loved ones land in the emergency room suffering a stroke or massive head injury, I really hope their medical care provider has been studying the latest science and technology and is grounded in evidence-based medicine. The point of requiring CMEs is to ensure us healthcare professionals stay current on the latest scientific developments and keep our skills sharp. Those include skills using our minds and the scientific process to critically examine research, as well as sort through bogus marketing claims. It makes one worry that if energy fields are confused for sound science, how well is unsound information recognized from the sound stuff when it comes to issues like preventive health, obesity and nutrition?

Looking at what is accreditated for CME credit hours, it appears many professionals can be sold about as easily as the general public. CMEs — offered through free and low-cost online credit hours, seminars and medical symposiums, organization meetings, and scientific conferences — have proven lucrative venues for marketing interests to sell their wares, pills and programs to healthcare professionals. Many professionals mistakenly assume that accreditation means the information is objective, reliable and has been carefully peer-reviewed. Not so. CME credit hours are accredited as easily as a sponsor paying a fee and filling out the forms, not on the soundness of the information.

Marketing has permeated CME considerably more than most professionals realize. Disclosures of conflicts of interests of those behind CME courses, which are supposed to safeguard that special interests don’t influence information presented to practitioners, are a muddy mess.

Roy Moynihan of the University of Newcastle, New South Wales, reported last month in the British Medical Journal that sponsor involvement in the education of practitioners is far more extensive than many realize, writing:

The visible signs of sponsorship at these events are obvious: the smiling drug company representatives, the colourful company logos, and the high tech stalls in the exhibit halls. But what about inside lecture theatres, where high quality education is delivered to doctors by respected speakers? Surely the sponsors have no input into those sacred places of independent education?

No so. His investigative report found that sponsors had roles in suggesting speakers and even ensuring the selection of speakers who would present a position favorable to the sponsor. While Moynihan’s focus was on pharmaceutical companies, just as common are vested interests promoting health foods, fitness, preventive health and “wellness” programs. And most overlooked are the commanding influences of nonprofit foundations, professional organizations, political action and patient advocacy groups, through which vast amounts of money from sponsors are filtered and with their own focused motivations. They are rarely considered for disclosures of conflicts of interest.

Disclosure policies don’t ensure the objectivity, balance and soundness of information presented in CME courses. Nor does simply making disclosures slow the flurry of CME credits paid for by sponsors, such as the Bariatric Surgery program for doctors offered through Discovery Health Channel and the University of Wisconsin Medical School, funded by Ethicon Endo-Surgery, Inc., the supplier of bariatric surgical supplies owned by Johnson & Johnson, Inc.

In an investigative report in the March 14, 2008 issue of the cancer research publication, The Cancer Letter, Paul Goldber wrote that while lecturers at CME events and authors of journal papers that offer CME credit are expected to disclose any relationship with commercial interests that has produced a benefit “in any financial” amount over 12 months preceding to the educational event,” there’s little oversight or consistency. He uncovered numerous examples of a cancer researcher failing to disclose patents in a series of CME seminars promoting lung CT screenings and in a journal article offered for CME credit.

The chief executive for the Accreditation Council for Continuing Medical Education, Murray Kopelow, told Cancer Letter that it considers a relationship relevant only if the content of the CME is about that product or service. But it appears that loop-holes are commonplace and ACCME admitted it has little enforcement power other than mandate for audits and “self-studies” or, in extreme cases, it can revoke accreditation or bar presenters from future appearances for failure to disclose conflicts or for presenting biased information. That seldom happens.

Let’s take a recent example of a major conference on childhood obesity offering CME. The skewed information wasn’t as obvious as purple light, but was it recognized?

Politics and marketing or evidenced-based medicine?

Doctors, nurses and psychologists were able to get 31 CME course hours last week at the annual meeting of the Society for Adolescent Medicine (SAM), in Greensboro, North Carolina. It was themed “Adolescent Obesity: Prevention and Treatment.”

U.S. Surgeon General, Dr. Steven K. Galson, M.D., MPH, made it a stop on his nationwide “Healthy Youth for a Healthy Future” tour. The opening address was given by Dr. Risa Lavizzo-Mourey, M.D., MBA, president and CEO of the Robert Wood Johnson Foundation, who described the “adolescent obesity epidemic, its impact on health and on society, and RWJF's vision for reversing the epidemic.” Nowhere in the program was there any mention that RWJF had commissioned the Institute of Medicine’s childhood obesity action plan, which had specifically noted there was no evidence for its far-reaching recommendations, or that Dr. Lavizzo-Mourey had called its initiatives “natural experiments taking place” on an entire generation of kids.

The speakers were introduced by SAM’s President, Abigail English, a lawyer who is the director of the Center for Adolescent Health and the Law. The keynote address was given by Kelly Brownell, Ph.D., MPH, director of the Rudd Center for Food Policy and Obesity, who spoke on the “alarming pace” of childhood obesity which “can only be attributed to dramatic changes in the environment that affect diet and physical activity” and told health professionals they needed to get involved in changing “schools, communities and the nation.” Thursday morning was devoted to “global perspectives” of a “pandemic” of adolescent obesity; while Friday morning, Dr. William Dietz, M.D., Ph.D., from the Centers for Disease Control and Prevention and fellow panelists, reviewed the “lifestyle modifications” necessary in the treatment of obesity, as well as the indications for medications and bariatric surgery in adolescents.

Did the doctors attending the conference learn about the findings of the U.S. Preventive Services Task Force which, after a comprehensive review of 40 years of evidence — about 6,900 studies and abstracts — on screening and interventions for childhood and adolescent “overweight,” found no quality evidence to support these childhood obesity interventions?

That information was nowhere on the program.

Did they learn of the report from the USPSTF expert Childhood Obesity Working Group, which strongly chastised medical professional organizations for not following the first principle of medicine — primum non nocere (first, do no harm) — by supporting these ill-founded initiatives?

That wasn’t on the program, either.

Did they learn that the CDC’s National Center for Health Statistics has reported that there have been no significant increases in the numbers of U.S. children considered “overweight” since 1999-2000?

That wasn’t on the program.

Did they learn that, according to the Dept. of Health and Human Services report, Health United States 2007, there is no medical evidence of a crisis of childhood obesity and that today’s young people are actually healthier and expected to live longer than at any other time in our history?

That wasn’t on the program, either.

How many doctors realized they were being sold?