He Who Pays the Piper

A physician I know forwarded me a link to an article he thought interesting. He also mentioned that he gets all of his continuing medical education credits from this same website for free.

Since this is the place I go for my state-mandated continuing medical education credits, I logged in to read the article. Although this article isn’t “for credit”, it’s spotlighted on the website when I log in.

Keep in mind that any old self-education does not qualify for credits required to maintain an active medical license. Category I credits must be approved through a mysterious (to me) process before being acceptable to state licensing boards.

This particular source of continuing education credits is funded by pharmaceutical companies. Logos and ads abound. The conflicts of interest are not secret.

I like to think that my smart self can filter out the repetitive pharmaceutical messages. I like to think that the often-used marketing premise, “repetition causes belief”, doesn’t apply to such a thoughtful reader as myself.

The initial messages of this article are that we psychiatrists must be tolerant of the beliefs of others and have professional boundaries with regard to our own religious traditions. Of course.

But I stumbled when I ran smack into the psychiatric flattery section of the article. Obvious ego-stroking sets off warning bells in my head, no matter where it comes from.

I couldn’t imagine how flattery of psychiatrists furthered the author’s premise, that one should be tolerant of alternative beliefs and have professional boundaries.

Flattery is one way to get an audience nodding and agreeing. A nodding and agreeing person is likely to continue to nod and agree. This is a well-known sales technique. It is also useful in consensus building.

The writer of this article says that “psychiatric values” are “derived largely from the liberal-democratic tradition, borne of the 18th century European Enlightenment.”

Then the writer goes on to stroke my psychiatric ego by saying “This tradition emphasizes reason, freedom, natural law, individual happiness, and an approach to healthcare decisions based on the value of their consequences (“consequentialism”).”

I found myself smiling and nodding inside. This is how I would like to view my work.

But these words, “reason” “freedom” “natural law” and “individual happiness”, paint a greater degree of “liberal-democratic” freedom than I’ve experienced at work. I’ve met individuals who’s drug compliance is required to access their money, remain free from incarceration and visit their own children. This seems neither “liberal” nor “democratic” to me. Perhaps this is this is what the writer means by “consequentialism”?

People who were not individually happy on drugs must still live with the consequences of weight gain, permanent movement disorders and giving birth to babies with cardiac defects. Is this “natural law” and “consequentialism”?

And I cannot use the term “enlightenment” when it comes to prescribing drugs with serious medical side-effects and efficacy in the range of an enhanced placebo effect.

The conclusion of the article I was given to read seemed to be that it’s okay for your patient to access support from his religious community so long as the religious community supports treatment with drugs.

My conclusion is that a website which baits readers with “free” continuing medical education credits, which are paid for by the pharmaceutical companies, may not the best place to go for professional information.

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Thanks or reading, thinking and writing.

Alice de Saavedra Keys MD