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chronic pain, Ethics

I just attended the worst CME lecture of my life…and what I did about it!

Yesterday concluded Pain Week, the largest pain conference in the United States (or so they said at the opening ceremonies). There were a lot of really interesting lectures, some very pertinent to my pelvic pain practice and others less so, but still interesting. For example, I don’t treat head and neck pain, but many pain patients have more than one pain syndrome so it is always helpful to know more about other pain syndromes, especially as pain in one area of the body can fuel pain elsewhere.

Much to my dismay, however, I attended what I can only describe as THE WORST LECTURE I HAVE HEARD IN MY CAREER and also the second worst lecture. I have heard other crappy lectures, but they were drug dinners not billed as state-of-the-art evidence-based medicine with CME credit. And kids, I expect a hell of a lot more from the latter.

The two speakers were ok, it was what they said that wasn’t. For starters, both lectures were opinion-based, not evidence-based. Promoted as state-of-the-art therapy, but what I can only responsibly describe as fringe, because I‘m the chick that starts checking weird sounding shit on Pub Med during the lecture (thank you Cosmopolitan hotel for your super-duper fast and free WiFi that requires no tedious sign-in or stupid video to watch). That is, of course, if I don’t have a clear recollection of the literature. I have a great memory, so typically I can remember most note-worthy articles as well as many that are less ground-breaking.

Let me tell you, basing your treatment protocol on a few animal studies is SO NOT COOL. If you want to do that crap in your own practice, well, let the malpractice chips fall where they may, but you CAN”T TELL PRIMARY CARE PROVIDERS IT IS STANDARD OF CARE! Typically, I like to see some phase 1 and 2 studies before making the leap from bench research to humans.

Some recommendations from one of the speakers bordered on dangerous (well, maybe not bordered because, I don’t know, breast cancer is NOT A DESIRABLE OUTCOME!). When I questioned the speaker during the Q/A time, my quoting the New England Journal of Medicine and the Woman’s Health Initiative were waved off.

The other speaker quoted therapies that he believed were standard of care, however, when I did my Pub Med duty I found that Cochrane reviews on his recommendations were equivocal at best. There were some promising small retrospective studies, but when that is the case, you don’t say, “This is what all you primary care providers should do,” you say, “This is a difficult area of medicine with not a lot of good research. I am using some small studies to guide what I do.” And then of course you quote the fucking studies! (not included in the slides/handouts, BTW). One speaker also advertised his book on the subject at the end of the lecture (so not cool and definitely conflict of interest as it was about pain medicine) and his own personal CME course offered through his private practice so I too could learn more evidence-baseless medicine clinical pearls from his own personal ivory tower.

What bothered me the most was that many attendees seemed to be lapping it up. However, a few of us who were shocked beyond belief gathered afterwards to share our utter dismay.

So I decided to make some noise. Too often we let crap slide. We give an average evaluation and then move on.

But that is not my style, because my lasso of truth travels with me everywhere.

Not only did I dutifully fill out my speaker evaluation forms, but I marched up to the organizers, demanded to speak to the person in charge, and then explained point-by-point why not only the one lecture was not CME, but that it was potentially dangerous. I asked for an additional evaluation form and then shared my thought that whoever believed those slides to be CME acceptable should be spoken with as well. Sadly, the second lecture happened the next day. Trust me, I was way beyond bold on that evaluation form as well.

Here’s a dirty little CME secret: not all reviewers know enough about the subject to actually screen the slides. Some who don’t review the literature to double-check, others let it slide. So, if there are no references on the slides, question what you are hearing.

I EXPECT evidenced-based medicine at a CME event, not opinion. And so should you. If there are no references it’s opinion until proven otherwise.

If opinion is being pased off as evidence at your next meeting, speak up. Considering how loudly I voiced my opinion, I am hoping the organizers of Pain Week will be more attentive and not let garbage slip through again.

Remember, we are ALL curators of medicine. All the time.

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Discussion

14 thoughts on “I just attended the worst CME lecture of my life…and what I did about it!

  1. Awesome… So glad to read your reaction. Unless clarified before we pony up the $ for the course, and unless clearly stated in the program— I agree 100% that the course should focus on evidenced based medicine — and perhaps conclude with potential treatments currently under study.

    Posted by Howard Luks | September 11, 2011, 7:23 pm
  2. I guess my first thought is ‘why a lecture?’Why get all those people face to face in a room and then lecture them even if it is the most up-to-date EBM ever. I can read that at home or online WHEN I need it. What is useful is to actually talk through what our experiences are in managing those conditions. How can we APPLY the evidence in order to make our practice better. What problems to we come up against? Why are some guidelines easier to implement than others?
    That would be real CME. But as usual we get delivered something not so useful.

    Posted by amcunningham | September 11, 2011, 8:05 pm
  3. kudos for insisting on a scientific evidence-based standard, and for calling out the speakers on their paltry arguments!

    Posted by W | September 11, 2011, 9:41 pm
  4. Way to go. Far too Many of us are willing to let t go, and I will admit to having done so in the past. Though I have gotten up and walked out on such a lecture. I now feel I should have said something. While it might be appropriate to mention trials to try to pass it off as standard of care is ridiculous and dangerous. Thank you for not Doing so, and maybe in the future I will follow in your example.

    Posted by Melissa Gastorf | September 11, 2011, 11:02 pm
  5. I respect what you did. However let me know if it did make a difference or not. Often organizers will dismiss what you did. You feel good you did it and they ingnore you (my email is info@healthykids.ca)

    Posted by Dr Peter Nieman | September 12, 2011, 1:51 am
  6. Too bad more pain docs weren’t on Twitter. Could you imagine the background Twitter channel of the attendees to a session like that had they been on Twitter and known how to follow a hashtag for the conference? This is one reason why I love Twitter. I mostly attend health IT conferences and so there’s almost always a Twitter back channel that calls out the BS that’s spewed from the speakers.

    I’m also with DSr. Nieman that I hope the organizers listen. Many don’t.

    I assume it was the Cosmo hotel in Las Vegas. Did you find the secret pizza place?

    Posted by John Lynn | September 12, 2011, 5:21 am
  7. Way to go, Jen. You did the absolute correct thing! More power to you for not being complacent!
    Even if it doesn’t help resolve the issues in that pain presentation or result in a change in that CME course, it still sends a powerful message to those who read your blog. That is even more important. Thanks so much for sharing what you did. I’m spreading the word. Love your energy!
    Kudos to you!
    Ellen :)

    Posted by Ellen Richter (@EllenRichter) | September 12, 2011, 2:02 pm
  8. Good for you; I hope you got your money back as well. BTW, this is the first time I have heard of this conference, and I have been in the pain research field for >20 years. There are a few familiar names, but it is not a research conference. The American Pain Society and International Association for the Study of Pain put on good shows!

    Posted by Geoffrey Bove, DC, PhD | September 12, 2011, 5:52 pm
  9. I like the attitude. ;-) But I’m curious to know what these alleged standards of care were. What treatment protocol was being prematurely touted? Details, details!

    Posted by Paul Ingraham | September 12, 2011, 6:31 pm
  10. Very well written and objective!

    Posted by Paula J Bell RN (@panightnurse) | September 15, 2011, 2:55 pm
  11. As a CME planner, I must applaud you for this. I cringe every single time I hear the word “expert” because that’s not reason alone to utilize someone as faculty. Too many times you see faculty follow their own personal agendas instead of considering what the learners’ gaps really are (not just their needs, but their gaps as well).

    Also, your post is an excellent example of why physicians who are “involved” in CME need to give a crap about what they are putting out there.

    Thank you.

    Posted by P.B. | September 19, 2011, 9:54 pm
  12. Nice write up! What were the topic names that were presented? You’d think that a medical conference wouldn’t JUST be opinion!

    Posted by Ryan | July 12, 2012, 4:20 pm

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  1. Pingback: What Do We Do With Bad CME? | Confessions of a Medical Educator - September 16, 2011

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