Viewpoint

When CME and education diverge

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

This year I made my inaugural visit to Dr. Robert Osher’s Sarasota course, “Cataract Surgery: Telling It Like It Is!” I’d heard rumors about the origins of the program and had a chance to sit down with the man himself for the story.

To summarize: Dr. Osher led the cataract section of the Hawaiian Eye meeting for 27 years. (I first attended this meeting back in the early 1990s when it was well known as John Corboy’s Royal Hawaiian Eye Meeting.) As time went on, the meeting got bigger, meetings merged and CME regulations became, well, draconian.

While Dr. Osher loves to teach, he’s also a rebel. He routinely breaks rules for the benefit of his patients that some of us only dream of breaking. So five years ago he got a “pink slip” suspending him from the meeting for a year. His crime? He had the gall to mention (I’m sure repeatedly) products by name in his presentation. Never mind that his lecture topic was on new products in cataract surgery. In true Dr. Osher style, he refused the suspension and insisted on a lifetime ban from the meeting. Some asked him to reconsider, but he had other plans for a different kind of meeting.

For presenters at CME meetings, things have really changed in the past few years. Speakers have to submit their presentations well in advance, which makes it difficult to incorporate late-breaking developments. For many meetings, someone is editing the submission. And, of course, speakers may not mention anything off-label, despite us practicing off-label routinely. (Remember: Pred Forte is not labeled for post-cataract surgical inflammation.)

So Dr. Osher created a new concept: A high-quality meeting with great faculty, topics, videos and wet labs, with no CME and no censorship, making it arguably the most intense cataract meeting around. Attendance this year approached 500 doctors and 100 exhibitors. He gave me the stack of post-conference evaluations to peruse. They were so positive it was silly. And my own opinion? It was indeed as valuable as people said. Never before had I been so humbled about my own surgical abilities.

Yes, valid reasons exist for reviewing presentations in advance and eliminating industry bias. We’ve all seen unbearably biased talks. But the exclusion of industry from our meetings and presentations has gone to extremes. All of these rules (think lawyers, regulations, central planning, etc.) have reached the point where they are negatively impacting patient care and the dissemination of information to doctors and patients. So I do understand Dr. Osher’s frustrations. What is the right balance and how do we achieve that? We must preserve the critical principle of free speech.

We all have to meet CME requirements for licensure, but much of my real learning is in non-CME activities. We need more venues for frank discussion. Hopefully in time the powers that be will realize the damage these well-meaning but overbearing CME rules can do to true learning. In the meantime, we will all try to keep “telling it like it is!” OM