A conversation has been going on recently on the Healthy Skepticism list-serv about how hard or how easy it is for physicians to stay up to date on new drugs and therapeutics without relying on sources that are controlled or heavily influenced by the pharmaceutical and device industries and their marketing juggernauts. Dr. Mark McConnell, who practices internal medicine in LaCrosse, WI, offered a set of highly practical tips that seemed too good not to share with all readers. He's given me permission to reproduce his how-to list, to which I have just a couple of additional suggestions.
Dr. McConnell states that by adhering to his program the necessary investment of time needed to stay reasonably informed and up to date is about 5-10 hours per month. (Like anything else, I'll add, when you just begin to start using any of these sources, it will take a bit longer; once you become used to how each works and where to locate the information you need, your time will shrink.) Dr. McConnell notes that he does not have a specific set-aside budget for CME and so he uses his own funds for these programs and sources.
His core resources:
Oakstone's Practical Reviews in internal medicine
InfoPOEMs from Essential Evidence Plus
Therapeutic Initiatives Drug Therapy review course
I just have two additional resources to comment on. One is a service that provides a monthly CD with an audio presentation and evidence-based discussion of 40 recent articles pertinent to primary care, along with a database that allows you to store all 40 abstracts each month on your computer and later search them--Primary Care Medical Abstracts, http://www.ccme.org/PCMA/index-frame.html, $279/year. Rick Bukatra and Jerry Hoffman present, discuss, and argue about the abstracts in a manner somewhat reminiscent of "Car Talk" on NPR.
Second, I have been a long-time satisfied subscriber of The Medical Letter, http://www.medicalletter.org/, $98/year. This is supposed to be the Granddaddy of all U.S. non-commercially-sponsored publications on therapeutics, having been founded in 1959. The Medical Letter was being criticized on the HS list for not being truly independent and for allowing companies to review its assessments of their drugs. All I can say in defense of my longstanding use of this source (when I was in practice, which I am not currently) is that the publication hardly ever endorses a new drug, and most often says that a new drug is really no better than an older drug. The few times I have mentioned this publication to a drug rep, he has pooh-poohed it vigorously and given me numerous reasons why I should pay no attention. So if the drug companies are allowed to see the reviews, it does not appear that they have much influence over what is eventually published. I'd appreciate more discussion of this in the Comments.
None of the above sources accept ads from industry.
Monday, March 8, 2010
Getting a Pharm-Free Education: What Works?
Posted by Howard Brody at 5:45 PM
Labels: Continuing education; CME
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I'm a GP and editor with Prescrire, a French CME journal with an english edition.
Yes, you can do without industry information on new drugs: just say no to sales reps for a start, and pay for your CME entirely out of your pocket. Only 2-10% of new products (depending of the year) make a difference, and an individual physician can't identify them on his/her own, you need to trust an independent journal to do that.
Prescrire allows companies to comment and challenge our assessments of new drugs after publication and in a dedicated section. Also we request unpublished information from companies when collecting the evidence, and we congratulate or name and shame them during our Golden Pill/Information Awards in January each year.
Editor with Prescrire
We found that there are many legit foreign pharmacies that provide for safe and reliable medications at much lower prices. The idea that only US pharmacies can provide quality medications like Vicodin, Hydrocodone, Lortab, norco, lorcet is obviously shallow. Foreign internet pharmacies will also often offer their patients a free online consultation. It would not be hard for authorities to recommend the use of such pharmacies to patients in need, but instead the DEA insist that the consumers’ safety is at stake when ordering at foreign pharmacies, since the safety can be compromised due to falsification and adulteration of the pharmaceutical products available in other countries is indicated findrxonline in article on pharmacies online.
Thanks for this post, Dr. Brody. I'm a medical writer trying to get "unhooked" from pharma-funded work. I often feel like Diogenes with his lamp, looking for an honest client. It's a desert out there. The sources you provide look promising so I'll check them out.
Bruce's point is a critical one. Journalists Shannon Brownlee and Jeanne Lenzer a while back were compiling a list of "pharm free" sources and had, I believe, hoped to make that publicly available. I need to check to see if their list is accessible and if so will post on it later.
Thankyou, Howard! I will post those resources on my new blog, once I get it up.
Online Pharmacy US and Buy Valium
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