Thursday, April 12, 2012

Topping the Pentagon's $500 Hammer, or, Back to the Basement of the YMCA

Many moons ago, there was a flap about a cost study that showed that the Pentagon had paid $500 for a hammer, and this was widely quoted as an example of bloated government spending and waste. Now we discover that whoever ordered that hammer quit working at the Pentagon and is instead in the CME business.

Still catching op on older articles, I come to the study by Dr. Jeffrey Tabas and colleagues at UCSF:
--looking at physicians' attitudes toward commercial funding of continuing medical education. The main take home message is that these docs, surveyed as they attended CME programs, agreed that when companies paid for CME, they introduced bias into the program, and that was not good. But the docs also shied away from paying any more themselves for CME registration and basically shrugged and said that CME could not survive without commercial sponsorship.

What most grabbed me, however, about the article was their observation that docs tended to way underestimate the actual cost of running a CME program. As an addendum the authors checked out the costs of various stuff at different cites in the US, presumably looking at big hotels or convention centers where CME events are often held. Taking Atlanta as a mid-range example, the costs per cup of coffee worked out to $7.47 and of a bagel, $5.05. If you wanted to splurge for lunch it would be $49.41. On the non-food side, the cost of getting a room set up with a screen, laptop, projector, and cables was $1520, not counting the cost of the technician.

So this led to a train of thought. We have to recognize (as was of course the case with the infamous hammer) that all these numbers reflect not the actual costs of the specific items, but what other charges and profits the business decides to tack onto that part of the tab; if we insisted on paying no more than $3 for coffee, the place would surely oblige, but simply add on the equivalent cost someplace else on the total bill. That being understood, I still have to wonder--if docs saw these figures, would they still agree that CME should proceed in the same way it always has, and that commercial sponsorship, while perhaps unfortunate, is nevertheless essential? Or would the light dawn that as long as a sugar daddy has been willing to pay the freight, others decided to take advantage, and so there's been an unjustified cost escalation in CME?

One of the quotes I most cherished when I was working on HOOKED was from a top dog at the American Psychiatric Association, who when asked by a reporter writing about their 2002 annual convention why they took so much Pharma money, protested that without Pharma bucks, they'd "be sitting in the basement of the YMCA." (Since then APA has made considerable strides in ridding their meetings of commercial money.) I had to wonder--has anyone asked the YMCA lately what they charge for a cup of coffee?

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