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.

* * * * * * *

Thanks or reading, thinking and writing.

Alice de Saavedra Keys MD


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


    • Stephen,
      I’m glad for your feedback on this. What a puzzle to “hide” in plain sight.

      It’s clearly posted which company is funding each article.There are ads flickering around the edges. The “for credit” articles are directed at prescribing specific drugs in conjunction with specific diagnoses.

      At the end of each article that a doc uses to collect “free” CME credits there is an optional evaluation form where you are supposed to tell them if you thought there were any visible conflicts of interest.

      I’ve been puzzled why this is the case.

      How accurate could this feedback be from a doc who just accepted the gift of free education credits? Is it a liability dodge for the drug company? It is simply a case of hands washing hands?

      Thanks for checking in on this one.

      Report comment

  1. Natural law?
    Are you kidding me?

    When I think of *natural law* I think of the works of Thomas Aquinas, John Locke, “moral law”; the Declaration of Independence, the Constitution, “common law”.

    I don’t conjure up thoughts of psychiatric drugs for some reason.
    Maybe it’s just me?

    I wonder sometimes if the mental health system has lost all sanity, which leads to two questions:

    1) Where are we going?
    2) Why are we in this hand-basket?


    Report comment

    • Phillip,
      Thanks for your kind words. Marketing is no longer simply showing us the brand name and saying good things about the product. “Subtle and Pernicious” is a good set of words to describe modern marketing. It includes both obvious and hidden flattery that makes us feel clever when we reach the “right” conclusion so nicely at the same time as it’s presented to us.

      Report comment