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One of the messages that I have taken away from the European Association of Urology meeting in Vienna, is the increasing complexity of treatment options for advanced prostate cancer.  However, I have equally come away with the impression that company sponsored sessions is not the right way to provide continuing medical education (CME), if not done in an independent way.  

There are 28 industry symposia at EAU in Vienna, each sponsored by one company.  That’s a lot! Of the sessions I have been too, all have prominently featured the company logo, name or some form of branding on the invitations, slides and meeting materials.  If you want more information afterwards, the pharma company (not any CME provider), will contact you. 

What’s more the slides presented are all in a similar format no doubt having been prepared by the company’s agency, and the content appears to have been carefully scripted to focus on the company’s product. 

So when sanofi-aventis at their symposia talk about prostate cancer and discuss one patient, it should come as no surprise that the patient ended up on cabazitaxel, and the only clinical trial data presented in any great detail was, you guessed it, for cabazitaxel.  “You can start using it tomorrow in your practice” was the underlying message.

The key opinion leaders (KOLs) at these sponsored meetings focus their messages where they have no doubt been directed. “In my hands cabazitaxel is well tolerated.”   It’s been fun to watch the same KOL turn up at different symposia, and focus his messaging on a different product each time.  A paid advocate for one product does not take his advocacy with him to another company’s symposia!

While I don’t doubt that the information each company presents is technically and factually accurate, it’s clear that the experienced KOLs know not to bite the hand that feeds and play the game. But should doctors have to attend multiple symposia to work out how to put the pieces of the jigsaw together?

The model I have seen at United States medical meetings where a topic is focused on, and sponsoring companies have no role in writing the slides, selecting the KOLs or scripting it, is far superior.  Fair balance and independence for CME activities are what doctors deserve in a promotional world. 

The challenge of quasi-promotional symposia such as the ones I have attended in Vienna, is that doctors can’t rely on the company sponsored session to help them understand how to view competing or different treatment options. As advanced prostate cancer becomes more complex, the need for independent CME becomes increasingly important.  European physicians should insist on nothing less.

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6 Responses to “Letter from Vienna”

  1. Sceptical Urologist

    Great post. Completely agree. I think eau2011 has been swamped in a tide of promotional activity which is not helpful

  2. @EuropeanCME

    Yes, an interesting post, but one that mixes many concepts and terminologies.
    1. Industry sponsored symposia are, er, … symposia sponsored by industry, not CME activities! For decades these have been sessions where the industry supporters of the congresses are allowed to “peddle their wares” to whoever wants to attend. They have never been “independent” nor promoted as such nor expected to be. Audiences vote with their feet and participate with eyes fully open to any potential biases – symposia like this are merely an extension of their promotional booths in the Exhibition Hall.
    2. Of course the pharma company will be the ones getting in touch. It’s a pharma meeting. No, you will not get approached by a CME provider, nor a plumber. Neither are involved in these meetings.
    3. Interestingly the author refers to the experts as “KOLs” – a promotional term, implying financial contracts between experts and pharma. We don’t have KOLs in CME – there is no “opinion” to be “led”, just evidence-based unbiased examination of the facts. We have a duty to keep KOL as a term used in promotion-land.
    4. …and the corollary…so when sanofi-aventis pays for a satellite meeting, guess what, they won’t be promoting any competitor products, nor discussing competitor data – do bear in mind that they don’t just do it this way for fun or out of choice, it is prohibited for them to discuss competitor products under the promotional code and illegal under various national and European laws.
    5. Etc. etc. etc. and yes, bears really do those things in the woods.

    I utterly agree wholeheartedly with the sentiment of the post, but one must understand the difference between promotion and CME – and strive to keep the two separate. Let pharma sell their products and let’s keep calling it promotion. Then let’s have CME and keep pharma separated from it – so that it really is independent and as unbiased as it can be. But it is utter madness to try to create or expect a single solution that satisfies both – this is the real danger that we, in Europe, face today (this post being yet more evidence).
    Absolutely, doctors should demand it and deserve nothing less – but they also need to know that CME in Europe exists!

    • Pieter Droppert

      Thanks for reading my blog and taking the time to comment. Firstly, my post refers to what I observed at EAU in Vienna which was:

      1. 28 Sponsored Symposia which were part of the official conference program, each sponsored by one company.
      2. They were not ancillary meetings, held at a hotel, but part of the official program, and took place in the same meeting rooms as other conference sessions
      3. The official congress staff scanned everyone’s badges on entering the symposia, so that attendance could be logged for CME purposes by EAU members
      4. All sessions at the Congress were eligible for CME, therefore I am presuming the industry sponsored sessions also qualified for CME
      5. In the conference program itself, the description for some of the sponsored sessions states “this medical education symposium” will….

      Therefore to answer your first point, I respectfully disagree that these meetings were clearly promotional and normal extensions of exhibits etc.

      My observation, and others are free to disagree, was that these meeting were sponsored CME events. In which case, they should in my opinion have ben prepared independently of the company, with fair balance and a panel of experts and consider all treatment options not primarily the one of the sponsoring company.

      I personally disagree with your view that this type of symposia is an acceptable extension of the promotional activity that takes place at exhibit booths. That’s not how medical meetings in the United States treat them, and just because something has been always done a certain way doesn’t make it the right way. As for your comment, that this type of quasi-promotional sponsored CME symposia is acceptable because doctors can freely choose whether to attend, I must respectfully disagree. Doctors are free to choose to go to any conference session and free to choose whether to attend the Congress or not in the first place, but I think that any official congress session (whether sponsored or not) should be held to an appropriate high standard of educational integrity.

      As for your comments about my use of word key opinion leader. I don’t necessarily think that this term is purely associated with promotional activities, to me it refers to those experts who are looked to by their peers for advice as a result of their clinical trials expertise, academic reputation etc. Those experts invited to chair or lead CME activities shape the opinion of other doctors, therefore they are opinion leaders. In my view an opinion leader remains one irrespective if whether he is doing CME or promotional work. Also if you want to argue that the meetings that I described at EAU in Vienna were promotional, then my use of the term KOL would be acceptable according to your view, so you can’t have it both ways.

      CME should be separate from promotion, and I think that the way it was organized at EAU in Vienna was not optimum for physicians, although it clearly has advantages for companies. If anyone who actually attended EAU in Vienna feels differently or believes my observations were inaccurate, please feel free to make a comment

  3. @EuropeanCME

    Thanks for your detailed and considered response Pieter.
    I think that what our exchange here highlights is the difference in understanding of CME on the two sides of the Atlantic. The meeting website is also not forthcoming on many things from an “outsider’ perspective, so much European CME involves implicit knowledge.

    To address your main points first:
    1, 2, 4. In Europe, a pharma-supported symposium is not considered to be part of the scientific programme, even if it takes place in the same room after an “official” session (hence the term “satellite symposia” which many meetings still use). Under EACCME rules (which this meeting followed for CME) it only counts the main scientific sessions and does not recognise symposia as being CME accreditable (which is not stated explicitly in the literature – but it is implied in Europe, and from experiences of past meeting I have attended, it would have been explained to delegates at the CME desk at the meeting when delegates could get more information/collect CME Certificates).
    That said, it is not impossible to have symposia individually CME accredited outside of the formal congress programme structure.
    3. Attendance at symposia has usually been recorded, but for mostly for tracking/demographic purposes, it is not an indication that it is CME. Traditionally claims for CME at conferences is not actually tracked – it is self-declared by the learner (wording on meeting website reflects this) – although with the rise in e-tracking through badges this is changing.
    5. Agreed. However in Europe, “medical education” does not mean CME. When this term is used for an activity with pharma-support, in my mind, it is a 100% pharma-controlled educational event (whether pure promotion or IME). It is generally accepted that symposia are not overtly promotional in character – otherwise the audience would walk.
    I really do understand the frustrations here. This is precisely why Peter and I set up the European CME Forum, to get the stakeholders in European CME together to discuss the issues. We have a very poor regulatory framework to define CME. Meanwhile in the US, with a mature multi-billion dollar industry that has attracted so much attention, they have had to clearly define so many terms and processes.

    I see that there will only be more clarity once we start to separate out “education” from “promotion”. Where “education” is independent, CME accredited, and separated from pharma. And “promotion” is anything pharma-controlled. This classification includes IME (which some may well describe these symposia?) – as this activity needs to comply with the promotional codes of practice, and commercial laws that the pharma companies need to follow – and I think is the best marker we have as far as definitions go. I have heard IME called “promotional education” in the US – but all these are terms alien to Europeans.

    As we see more funding for European CME from pharma becoming centralised (and even controlled out of the US) there is an ever-increasing need to clarify all these terms – not just among pharma, but also Providers (we don’t have many “CME Providers” in Europe as promotional agencies can still be involved in CME) and most importantly, the medical societies (who control these congresses) and the accreditation bodies (a problem that doesn’t really figure in the US with everything so clearly defined/managed/controlled by AMA/ACCME/etc.). It will need be be a European development, at the moment I do not see the US model as a viable option.

  4. sally

    Good debate here folks. Having just returned from EAU myself, I must completely agree with Sceptical Urologist. The promotional tide, both the sheer size and volume of it, was overwhelming and embarrassing.

    I think it’s one thing to have ‘sponsored symposia’ and another to have CME, but mixing Church and State is a recipe for disaster, or even the suggestion of it.

    Here’s the problem, Eugene – take a look at the actual programme book – one example is included for posterity here so we can all take a look at the messaging and mixed metaphors:

    The book clearly stated that:
    – The sponsored sessions (approx 8-9 concurrently each evening!) were part of the “EAU Programme”
    – It does make it clear that it was “Sponsored” in this case by Prime Oncology, who were hired by Dendreon to run it for them, which I think was a smart move and very ethical/independent.
    – The page also clearly states that CME was available.

    Other company sponsored session pages were similar, but some were more vague using language such as “this educational session…”

    The thing is, it’s not really an educational session at all if only includes one company’s messages, and promotional ones at that. You might as well bluntly call it “Corporate Symposia featuring Company X’s promotional blah on Product Y” a bit strong perhaps, but that’s essentially what they were and it wasn’t pretty in the 3 I attended.

    Many of the attendees were residents and young urologists and oncologists looking to educate themselves about the new developments in the various areas. How can we best accomplish that if they only hear one perspective on one product in one session, and a biased one each time? How can they assemble a picture and understanding of how to treat their patients this way? I think it would be hard to do and ultimately, the industry is spending huge amounts of dollars doing this while not advancing medical education optimally in Europe.

    Surely a better approach would be to have a fair balanced and broad session on all existing and emerging therapies in say, castrate resistant prostate cancer or over active bladder or whatever, with sessions run by the Society, put in context by the respected experts and paid for by the doctors themselves?

    Wouldn’t that approach be fairer and lead to better educated doctors who have a deeper understanding of the disease and be able to make rational clinical decisions based on the data unimpeded by marketing messages and promotional spin?

    Just a thought.

  5. @EuropeanCME

    Sally, thank you for coming in. Yes, in Europe it would be better to have CME-accredited programmes rather than the symposia run as the “promotional” thing that they are. I am in complete agreement with you – and sang along to the words of the second half of your post – I have been working to these principles for years, my articles and activities in CME are easy to find online.

    Yes, the EAU wording could be clearer, but in Europe we have never had symposia accredited for CME as a matter of course, people have always known and been informed that these meetings, on the whole, are initiated and presented, whether explicitly or with self-imposed limited control behind the scenes, by pharma. The speakers will be declaring their involvement on their next CoI declaration as well. And it is not unusual to have 8 or 10 concurrent sessions – we don’t have concepts like unopposed symposia over here. Symposia have never been part of the scientific programme of a congress.

    I mentioned in an earlier post that it is possible in Europe for companies to follow CME procedure and have their symposia CME accredited independently. Just to confuse things further, I suspect that the example you have given was in fact CME accredited, Prime Oncology is an independent CME Provider and works this way. But they would have taken responsibility for this themselves and had it accredited outside of the EAU congress process – details would have been available to the delegates in the room – not in the EAU Programme book. Most of the symposia at EAU will however be medical education as we call it in Europe, in the US you may call it promotional medical education, falling under the requirements of the pharma promotional code of practice.

    Of course it will feel strange to you and you will feel uninformed. As I do when I see pharma product commercials on TV in the US, or the weird debates the US had around healthcare reform, or how Capitol Hill gets involved in CME. From my personal perspective pharma shouldn’t sell directly to patients, the US should adopt the superior UK-style NHS, and everyone should run the extraordinary yet inspirational CPD system that the RCGP does in the UK. But I suspect/know that none of this would work in the US. Even though it works for us.

    Whatever the reasons, CME in Europe is just different to how it is done in the US, and Europeans are not quick to adopt many US-style solutions – so it will continue to be different for a while yet.

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