Q&A with Thomas Sullivan: Medical education companies don't deserve media abuse
Thomas Sullivan founded Rockpointe Corporation, a medical education company in 1995. Since then, the company has had success creating continuing medical education materials with funding from big drug company clients and nonprofit groups such as the American Heart Association. On his blog, Sullivan and Dr. Daniel Carlat, the founder of the Carlat Psychiatry Report, have a friendly argument going about the role of the drug industry in health information for practitioners. I recently reached Sullivan on his commute home from his office in Columbia, Md.
A recap of the first part of our conversation is below. The second part will be posted next week. It has been edited for space and clarity.
Q: You have written on your blog about having a passion for educating health care providers. When your company is hired by a drug maker to put together a continuing medical education program how do you insure that your passion is truly put to educational use and not channeled into a much bigger marketing effort?
A: For one, it's not as much of a hire as a grant. We actually go out and apply for grants. We file paperwork and apply for grants from government or from a foundation or from a company. If you wanted to, you could apply for grants to do this CME work, as long as you are an accredited provider. Often we will say, in COPD for instance, "What can we do to educate physicians on the practical issues on COPD?" We did a program this weekend where we spent 45 minutes of a four hour program teaching doctors how to use spirometers. We brought the doctors in and taught them how to do this to show them the process nurses go through to get these results. We try to focus on more practical learning for physicians.
Q: Who comes up with the ideas for the CME classes?
A: We have MDs and PhDs on staff who come up with the ideas. And they are very creative people.
Q: So your business model is: you come up with the ideas, then you seek funding through grants, and then you are paid by the practitioners to take the classes?
A: In a lot of cases the pharmaceutical companies give us a grant for the practitioners to take the classes, too.
Q: Why are the drug companies paying for the doctors to take the classes?
A: It's part of their public health mission. They are trying to make sure that doctors are as up to date as possible. It's the translation of science to medicine. It's taking what's available in science and translating it into the clinical practice.
Q: But even in submitting the grants, aren't you having to tailor your message to insure that you get funded?
A: Yeah. But they're not as particular as you think. Most of the companies just want to fund good education.
Q: Have you ever received funding from a company for a program that didn't mention a therapy that was part of their product line?
A: Oh, yeah. Like we did a series on end-of-life care, and there were no therapies involved in that, but a drug company sponsored it.
Q: Let me be more specific. Have you received funding from a company for a program that mentioned someone else's therapy but not that company's therapy?
A: Yup. I have done that.
Q: Can you give me an example?
A: I would have to go look for an example, but I know we've done that. We did a series on osteoporosis where we talked about all the therapies. It wouldn't be fair not to talk about someone's therapy.
Q: If there were no drug company funding, would your company still be in business?
A: We would have to make a transition. It would be difficult, just like anything else. There will always be a need for doctors to learn. And, this is America. It's fine for a company to say, we'd like to help support this.
Q: But, again, how do you make sure their support does not help tailor the message?
A: All our information is reviewed by an outside independent physician with no ties to industry to look to see if there is any bias. We do a very strong vetting with our faculty to make sure if they have a conflict, there is someone else reviewing their content. We send them a disclosure form before we ever even engage them.
Q: Before you bring someone in to teach a CME class, they fill out a disclosure form and then you decide whether they should be allowed to teach or not?
A: It's not so much stopping them, but putting them in a different place in the program. Someone who does a lot of work for a specific company, we might put them in a specific therapeutic area versus having them make recommendations.
Q: I'm not clear on what you mean.
A: We have had doctors who have had patents on tests, and we have not included them in the program because it's an unresolvable conflict of interest. We have had other doctors who do consulting or do promotional speaking with a company and we will put them onto something else like talking about the number of people who are affected but not directly talking about the therapy.
Q: Is there also disclosure of those conflicts?
A: We do disclosure before presentations and disclosure in the handout materials for the live meetings and on the Web.
Q: The Milwaukee Journal-Sentinel has written a lot about drug industry support for educational programs. You have been critical of some of that reporting. What is your main complaint?
A: I think the Milwaukee Journal-Sentinel reporting is only looking at one side of the issue. They are saying he did a program and talked about X, and it was funded by that company, so there must be something wrong with what they did. They talked about testosterone and referred to a program that was finished in 2006, but the reporters were saying that it wasn't valid because of science that had come out in 2007 and 2008. If you don't quote years on studies when you do your reporting, critics can say the latest medicine says blank. But maybe the medicine at the time didn't say blank. It's important for reporters to get the full picture and not just go to the same sources over and over again and to have people who are experts in that therapeutic area talk outside of just the ones the attorneys are sending to you.
Q: Which attorneys?
A: The legal community is providing the names of experts who are going to discredit the drug companies. There are big cases going on, like the one with Wyeth and HRT (hormone replacement therapy). In that case the attorneys are going to reporters and trying to discredit some of the guys who have been involved in HRT research.
Q: But isn't the issue that so much of what the drug industry does is secretive? Regardless of whether the researchers themselves are credible, they aren't being clear about their ties to industry and the industry isn't being clear about what it is funding. In the Journal-Sentinel stories, they found that the University of Wisconsin had been using industry funding for hormone therapy education without telling people about the industry funding. When the paper started asking about it, the Web site for the program was pulled.
A: They're not very secretive about it. Every program we do, we tell everybody who supported it. In all 13 years we've had doing CME programs we have always included the names of the supporters on the front of all the literature. There's no ambiguity about who is supporting it.
Q: The Boston Globe just published a story about doctors in the Boston area collectively taking a half a million dollars in industry funding in 2009 and, in some cases, violating their hospital's policies. There have been congressional hearings. There have been court battles over releasing records that include the names of doctors involved in this industry-funded work. How can you say that's not secretive?
A: Only one doctor has resigned over this. And that was Charlie Nemeroff at Emory. All the other (cases) have been basically innuendos. The rules are not well written. The things that become embarrassing are usually because someone didn't understand the rules or the people going after them didn't understand the rules. A guy who had a patent made $20 million in royalties on his patents, and that's called out as something terrible. But that's what we want, right? We want doctors to invent products, don't we? He reported that patent correctly, yet it was assumed he did something wrong. Dr. Alan Schatzberg at Stanford: The press came out and said he didn't report his ownership of stock. And Stanford looked into it, and, yes he had reported it. What's happening is the politicians are releasing these records and then reporters are going out and looking for something. If you were going to do a story about Tom Sullivan and say, "I'm hoping to find this out about Tom Sullivan," it's not exactly very fair, is it?
Q: I'm not clear on your example. Are you saying that if I were to try to do a story about your conflicts of interest, and I asked around about those potential conflicts, that wouldn't be fair?
A: No. What I'm saying is without even making sure their facts are correct, members of Congress are releasing letters that they are sending to companies asking for information and these letters have become the source of 95% of these stories. There's something wrong about reporting about someone before you even know if what's being said about them is true.
Next week: Sullivan says reporters are overreacting to ghostwriting cases.