Q&A with Thomas Sullivan: Part 2: Medical education companies don't deserve media abuse

Thomas Sullivan writes the Policy and Medicine blog. He also runs Rockpointe Corporation, a medical education company that works with nonprofits and for-profits to create continuing medical education (CME) programs. As company-sponsored CME and ghostwriting by companies has come under fire, Sullivan has become an outspoken advocate for medical education firms.

The first part of our conversation was posted last Friday. The second part is below. It has been edited for space and clarity.

Q: To follow up on what you said about how stories about doctors working for industry are coming to light, I'll give you one example. Gloria Bachmann has been written about, and it isn't because of letters that have been released by senators or congressmen. It's because of the actual correspondence between her and the medical education company, in this case, DesignWrite.

A: We're talking about apples and oranges. We're talking about disclosing conflicts of interests in CME versus ghostwriting.

Q: Those two things aren't similar in your mind?

A: No. In one you're talking about the guy publishing a paper and using the company to write it. We don't do that. The doctors we work with have no direct contact with the funders. And most of the time they don't even know who is funding the work. They are just out there to present good science.

Q: So your company doesn't follow the same pattern as DesignWrite where you are acting as a middleman between the company and the doctor and hiring the doctor to do work that will, in essence, present the company's message?

A: That's a direct agency contact, in my mind. That's a whole different field within medical communications. That's considered publication planning. These are people who work with the industry to make sure that papers get out. "We have this paper and we have to make sure it gets out in certain publications." I have read the stories on ghostwriting, but we don't do that. I would say that by calling it "ghostwriting" it makes it sound a lot worse than it probably is.

Q: Ghostwriting isn't a new term. Why don't you think it is accurate?

A: It's not that it's inaccurate. It's that it sounds bad, when it's really something that has always gone on. Professors have always used ghostwriters, whether its university under-faculty or outside help. How many graduate assistants wrote papers for their bosses when you were in school? I didn't see a lot of professors in the engineering department at the University of Florida writing papers. They had their TAs write papers.

Q: But those TAs would often be given credit. They would be named in the paper, sometimes as authors.

A: The bottom line is there are a lot of grunts in all of science turning out papers. Last week JAMA released a paper at a meeting, and The New York Times wrote about it. The Times had to publish a correction saying that the study didn't look at whether the ghostwriting was funded by industry. It was just about ghostwriting in general. It had nothing to do with industry funding.

Q: You have been critical of The New York Times and the Los Angeles Times, too. Where have you seen reporting in the major media that you think does a fair job covering this whole issue of industry-funded CME?

A: I don't think the media has done a fair job of reporting it. You can sensationalize just about anything and make it sound really bad if that's your goal in life. I was just talking with one of our medical science liaisons who has been in the field for 40 years and saying, I would like to have reporters come in and see that we're just regular people trying to do a regular job. There is no scheming behind the scenes with drug companies. It's very straightforward. We are going to educate doctors about this, and maybe some company will pay for it. Where do doctors need help? We do needs assessments with CDC data and other data to see where the educational gaps are. I think it's very easy to say they got money, therefore they are evil. But A doesn't always equal B. People don't' scream that the Robert Wood Johnson Foundation gave them money and therefore it's evil. I admit that the pharmaceutical companies have been on the hot seat lately. But these people are trying to make drugs to help people live longer. They have been profitable but I don't' think they have been out of line. Look at the proof. It's empirical evidence. If we look at what our life expectancy was 50 years ago, death from heart disease was 50 or 60 percent of the population. Now it's down to less than 20 percent. Our life expectancy has increased by 20 years. At no time in history have we seen this convergence of science and industry and seen a huge benefit from it. You can't say that we are extending life because of diet because everybody is overweight at this point. The medicines that are helping us live longer were developed through partnerships with industry.

Q: You have said that you think Dr. Daniel Carlat, a leading critic of industry-sponsored CME, is out to stop the production of all drugs. I have talked to him, and he does continue to prescribe medications. Do you really believe that he and other critics of the pharmaceutical industry really want to destroy all drug research?

A: They're not after research. It's an interesting thing. Carlat said we will allow industry to do research. Where do these guys come up with the authority to allow or not allow someone to do research? If you are going to do research on something you are going to try to create the best drug ever. So, if companies can't market their products and make sure that doctors understand how these things work, they will fail. I don't think these critics are trying to stop the production of all drugs, but I think that in their heart of hearts they think there is this magic formula where drug companies will have unlimited resources to make products without being able to sell them. With pharmaceuticals, it's a huge risk-reward ratio, and just because they are profitable today doesn't mean they are going to be profitable tomorrow.

Q: When Pfizer stopped funding CME this summer, you asked the question, "was Pfizer trying to send a message to all those who faithfully deliver unbiased CME?" I assume you include your company in that category. How do you answer that question?

A: No. I think it's their prerogative to cut their expenses.

Q: Did you do work with Pfizer?

A: We had done work with them. We were in the middle of working with them when they made that announcement. We don't get any more direct grants. They were very honorable about it. It's a smart pharmaceutical company.

Q: You have likened ghostwriting to bill writing in Congress, saying that "how many staff members of the U.S. House of Representatives and the Senate will be paid for work they do on the health care bills?" For critics of ghostwriting, your analogy actually makes their point. When a lobbyist writes a bill for a congressman, they are distorting the process to achieve their goals and their work, indeed, is rarely disclosed. Do you agree with that?

A: I don't know about the distorting. I don't think they're just handing bills to members. But no one ever quotes who the staff person is, do they? You don't hear the president getting up and saying the person who wrote this speech is this person. There is a whole lot of ghostwriting going on in the world as you are fully aware of that helps the world get going.

Q: Wouldn't you agree that there is a difference between a freelance medical writer, like some good friends of mine, helping a researcher put together a draft for submission to JAMA and that same freelancer putting together a draft and running it past the folks at Wyeth before it was submitted to JAMA?

A: It depends on if it's an independent study or not. There are company-driven studies. Especially in pre-clinical phase one or phase two where the company is driving the whole ship, where the lead investigator is probably a company employee. I don't think it's probably the best idea if you are doing a blind clinical trial to hire a ghostwriter. You need to do the manuscripts yourselves. The company can give them the funding to hire the writers, but they shouldn't dictate what's written. And I don't think for the most part that's what happens.

Q: If you are serious about showing reporters how medical education companies work, would you be willing to share your early drafts of CME work and then what happens to those drafts after the drug company gets involved?

A: It depends on who the reporter is, but yes. It would be a lot of paper, though. You're submitting grant requests, so you are going to be following whatever you have submitted. There are no back and forth drafts between us and companies, so there won't be a story there. Companies don't look at what we do before we put it out.

Q: Are you any more concerned about the future of your industry right now than you were five years ago?

A: Oh, yeah. Things are changing. It's health care reform time. It's an uncertain time. But doctors are always going to need education, and so there always will be a role for companies like ours.