Thursday, July 27, 2017

MOC® and Academic Medical Centers' Reliance on Pharmaceutical Funding

Recently, the American Board of Internal Medicine (ABIM) has touted its evidence base for the need for Maintenanace of Certification® on their website and via Twitter. Examining this "new" evidence base critically for its conflicts of interest is revealing and sheds light into how MOC® is used to support academic medical centers.

It took just one reference from ABIM's MOC® references to do so.

The very first reference currently cited on ABIM's MOC® reference webpage is this one:
Heitlinger LA. Do maintenance of certification activities promote positive changes in clinical practice? J Pediatr Gastroenterol Nutr. 2016; 64(5): 655.
The article, submitted Nov 23, 2016 and quickly approved by 2 December, 2016, claims "The author reports no conflicts of interest."

If there's no conflict disclosed, why keep looking for one?

Because in my experience, ABIM's MOC®-supporting references rarely, if ever, disclose their true conflicts of interest. Since MOC® is always about the money, we must follow the money to determine Dr. Heitlinger's conflicts of interest.

As expected, I didn't have to look very far.

Dr. Heitlinger's review of Sheu et al's article entitled "Outcomes From Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules" (that appeared in the same issue of the Journal of Pediatric Gastroenterology and Nutrition) claimed:
"The study demonstrates that at least for the period of observation that patient care is improved by participation of the diplomates enrolled in the activity."
What was the activity? A chart review and data collection. How patient care is actually improved by these activities remains suspect.

More important is what Dr. Heitlinger failed to mention in his conflict disclosure:
  • The Journal of Pediatric Gastroenterology and Nutrition is owned by NASPGHAN and its Foundation

  • Dr. Heitlinger and Dr. Bousvaros (one of the co-authors of the Sheu et al article) serve on NASPGHAN Foundation's Board of Directors

  • Sheu et al's study was completely "sponsored and developed by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) subspecialty field-specific quality improvement (QI) activities to provide Part IV Maintenance of Certification (MOC) credit for ongoing certification of pediatric gaastroenterologists by the American Board of Pediatrics."

  • Of the 134 participating gastroenterologists in Sheu et al's study, "most (94%) were NASPHGAN members."
So what is NASPGHAN?

According to their website:
"The optimal way to advance your career is to become an active member of NASPGHAN. Membership in the society is comprised of pediatric gastroenterologists, research scientists, and physician nutritionists with a major and sustained interest in the area of pediatric gastroenterology, hepatology and nutrition.
One only has to look at the NASPHGAN Foundation to understand why membership with NASPGHAN is so important to academic medical centers.

What is the NASPHGAN Foundation?

It is a tax-exempt "non-profit" 501(c)(3) organization endowed by pharmaceutical and medical device industry "partners" that distributes its educational and fellowship grants to academic medical center researchers.

MOC® and its myriad of Part IV "Quality Improvement" (QI) projects appears to be one way academic physicians can pad their CVs in the name of keeping the pharmaceutical and medical device industry funds flowing to their academic medical centers.

Conflicts?

Nothing to see here folks.

I hope this post helps educate my readers how to uncover academic conflicts of interest that exist in many journals beholden to the pharmaceutical and medical device industry.

And when it comes to MOC® improving patient outcomes through QI projects, caveat emptor.

-Wes

References:
 NASPGHAN's 2015 Annual Report
 NASPGHAN Foundation's 2014 Form 990.

5 comments:

  1. Typical of all MOC research. It's all done either by the ABMS and cronies or funded/supported by special interests. It's all smoke and mirrors to endorse the big payday. Fan back the smoke, and you wee there is not even an ounce of meat on the grill.

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  2. ABMS: A story of two conflicting roles and realities: regulation and promotion. For a scientific body that is supposed to simply test physicians we can see problems with both modes of reality and roles. But put the two roles together, of self-regulation and self-promotion, and you have a very explosive and dangerously powerful cocktail that no testing company should have under its authority. I find this more than problematic.

    Many physicians and patients, too numerous for the ABMS to count, have literally been shoveled into an unmarked ditch by the ABMS and their member boards. No moral sense or any pure science could ever supports such heinous acts as are occurring.

    People turn a blind eye or are completely oblivious of the facts. That is why I find this blog so unusually valuable in that the author attempts to present difficult to accept facts. How could organizations do such and such to harm people? How could colleagues in medicine do so much harm in the name of science, or good, when there is little to nothing of either.

    The history of the ABIM, which has been highlighted on this blog is a case in point.

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  3. The ABMS is not unique in its corruption and self-dealing.

    There is a parallel study of a dangerous organization with a cocktail of regulatory power and tasked itself with the promotion of its own "agency", an agency whose corruption, power and money-seeking eventually brought about its own demise. Its demise occurred after only three decades of official power to regulate itself, while being endowed with the unabashed means to promote itself and attract a great deal of money.

    The organization I am referring to created pure objective evil for millions of unsuspecting Americans and others around the world. This agency, whose roots also began in the 1930s that I'm speaking about was the AEC - Atomic Energy Commission. Its executives and board members, like the ABMS and their member boards and directors, conducted secret potentially harmful experiments on human populations without permission and sought control over its clients. Many of the harms it was doing and the unintended consequences were known at the time of its "experimentation", but a great deal of the ills only became known and admitted years later.

    When one hears any of the self-promotion regarding the value of MOC and the ABMS it makes me shudder. The public faces they choose to represent them are like phony bobble-heads who purchase their car collections and expensive guest dachas. While their executives take advantage of first-class/spousal travel, they take liberties in huge additional expense accounts, and indulge themselves in do-nothing luxury retreats. They purchase real estate office buildings as investments, create private for-profit business enterprises on the side. They get deferred retirement and extra deferred moneys tossed in to special accounts that nobody knows who they are for. They receive bonuses, and sometimes extraordinarily unbelievably high bonuses. They moonlight with conflicted enterprises and look to make a market off of others' suffering. Executives practice the art of non-profit double-dipping into dubious foundations, and get overseas kickbacks from who knows who, while at the same time their names get put on questionable related research entities on schedule R in the tax returns - all of it created not for the public welfare, but just to pad their already egregious incomes.

    Even the AEC did not go this far in its self-dealing and self-inurement. But with both entities one can be sure that the lines between corporate and government entanglements and serving special interest are very blurred with revolving door appointments, and so on.

    The AEC was, like the present day ABMS, also just as irrationally difficult to deal with and had its head buried in toxic sands, refusing to admit its lethal mistakes as it focused on growing its own power and global promotion. Like the ABMS it created a great deal of waste that they did not know how to contain or deal with - especially the unintended consequences of its poisonous fallout.

    Perhaps some cannot see the comparison, but the ABMS has also done a great deal to harm the health of human populations, in America and around the globe. The corruption of the ABMS and AEC present with the same kind of problematic conflicted self-promotion and self-regulation. The tale of the now defunct Atomic Energy Commission regardless of what one thinks about the comparisons tells us how important it is to question things. To really take a look and see with our own eyes how poisonous such powerful organizations as the ABMS and AEC can become.

    From looking at the rise and fall of AEC the question stares at us in the face: how can an agency that regulates be the same agency that promotes itself and be free of conflicts and corruption. The AEC also created "scientific studies" to support their positions. But most often they experimented and carried on without proof or verification. They did a lot of harm in the name of public good.

    What happened to the AEC? After years of abusing its power and destroying public trust the organization was shut down in 1974.

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  4. To those ABMS executives who can prove good (with their MOC) can they prove no harm?

    I am not surprised when I read or hear statements pointing out the dearth of evidence or data to demonstrate any positive benefits from the ABMS maintenance of certification program. I am also not surprised there is no established scientific linkage whatsoever to improved patient outcomes resulting from physician participation in ABMS MOC.

    I am surprised, however, when I repeatedly see obviously false reports, surveys and studies published by egregiously conflicted individuals connected to the ABMS or its affiliates who consciously fail to provide the public with even an inkling of their compromising relationships. This deception is tantamount to public fraud. Last time I consulted with an attorney, such deceptive business practices have been linked to criminal behavior and fraudulent consumer transactions resulting in harsh legal consequences and sanctions.

    The ABMS' own employees and related third parties are the ones who invariably do and promote the pseudo-scientific studies. These authors are today little more than street vendors who are in fact telling the public and their clients that their new product or service "x" will do such and such based on "old doc Holiday's" proprietary self-evident studies. It's beginning to look a lot like Tombstone in "the days of the "Wild Wild West at the ABMS.

    It should be obvious by now that the ABMS employees, and the overly-compensated "miracle quacks" hired to dupe the public, are promoting an unproven elixir as a wonder cure for a non-existent ailment that they also distilled from the same tainted corn mash. I am speaking about the need for ABMS MOC.

    It is apparent to most that the ABMS executives and their member boards have been drinking far too much of their own ever-changing policies, unhealthy tonics and bad elixirs. They have gone blind from being totally unaccountable to anyone and much too heavily invested in their own hubris and self interest.

    Excuse me for interjecting this fact, but the ABMS and their member boards, which as far as they tell us with their studies and historical analysis were all created to protect the public from "fraudulent street vendors". The ABMS was created, we are told was to protect the public from losing hard-earned money on these vendors with the "fake medicine shows".

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  5. "Woe Nelly!" Hold on to your horses. Things ain't exactly as they say at the ABMS.

    Every student of history knows that all things eventually deviate in time turning into their opposites. We all know the horror stories where "religions of love" have been turned into organized foreign interventions, bloody conquests, and even torturous inquisitions. When good ideas become distorted in the hands of self-serving and all-too often tyrannical people, it is time to take immediate action to find remedy for the ills they create.

    In case anyone missed the point, it is just very surprising how quickly the ABMS has become its own opposite. The ABMS and their member boards (and compromised and even corrupt affiliates) after only a few short decades have become the "fraudulent street vendors" with the trademarked "pseudo-science".

    The ABMS umbrella and their member boards created with MOC a hugely profitable enterprise. And everyone can plainly see it has become today just one big "medicine show."!

    A case in point

    Professionalism and Accountability: The Role of Specialty Board Certification
    Christine K. Cassel, M.D. (by invitation) and Eric S. Holmboe, M.D.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394686/

    Question to the ABIM/ABMS/ACGME quacks? Are either of the former ABIM's top authors mentioned above actually licensed to practice medicine? And if they are practicing medicine somewhere, or somehow presenting themselves as doctors, is this not a form of fraud?

    With all the harm they have done with their "promising oils" and "toxic elixirs" have these fabulously rich medical leaders not just become their opposite also?

    Snakes biting their own tails?

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