Sunday, June 28, 2015

Call to action for YOUR "bucketlist" from Medscape

Because you need to sign in and many wont:
Be a Hero for the Medical Profession
It's hard to be a doctor in today's healthcare environment. But instead of feeling defeated, many doctors are finding creative ways to defend their profession.
Paul Kempen, MD, an anesthesiologist at Weirton Medical Center, West Virginia, is one of them. Together with several other physicians, he spearheaded "Change Board Recertification," a national movement of physicians committed to reforming the board recertification process. Because physicians are "natural lifelong learners," continuing medical education (CME) and peer-reviewed journal articles should be sufficient to advance their knowledge, he says.
Grant Simons, MD, director of cardiac electrophysiology at Englewood Hospital and Medical Center, Englewood, New Jersey, feels that employed physicians will need some form of labor union dedicated to advocacy. "I want to play a role in the formation of an organized labor entity for doctors, so we'll have a better negotiating position when dividing up bundled payments. I want to be the George Meany for physicians."
(Shown) Abraham Verghese, MD, physician-author, Professor for the Theory and Practice of Medicine at Stanford University Medical School.

Thursday, June 18, 2015

Latest communication with the JACR editor regarding MOC Establishes clear support of MOC by these editors!

Dear Dr. Kempen -

Thank you for your continued interest in COI as it relates to a May 2015 publication in the journal by Dr. Guiberteau.

As I wrote you earlier today, the journal will soon publish an erratum noting the failure to disclose. However, in your email to me earlier today, I found several misconceptions in the following paragraph, which, for the record, I wish to correct:

"In conclusion, I regret the need to go through the Publisher regarding the COI, but remind you that my clear attempts to point out this intentional deception by the ABR and Dr Guiberteau were unsuccessful via direct communications with you.  The disclosure at the bottom of the publication clearly provides upon very superficial review enough information to demand ABR associations from that author, who gives his Email as at that board-ABR. I am also sure your journal approached these authors directly through the ABR/ABMS to provide a counter point view-just how they would otherwise become involved would otherwise deserve specific mention in your upcoming statement/publication."

1. You said I was non-responsive. However, I answered your initial email almost immediately. Following your second email, a day elapsed, during which I expended some effort researching this issue, before I wrote a response.  If this is being non-responsive, the fault lies more with your expectations than with my actions.
2. I found no justification for your charge that Dr. Guiberteau intentionally tried to deceive readers, nor can I understand why he might want to do so. Do you have some special power that enables you to discern intent?
3. You are incorrect that I approached Dr.s Guiberteau and Becker through the ABR or ABMS. I wished  to publish Dr. Jha's interesting take on the Board and believed readers would benefit from the conventional view. I know both Dr. Guiberteau and Becker, and they seemed the best options to provide the counter-perspective. I recruited their response directly with the authors.
4. There is the implication in what you wrote that Elsevier forced my hand in responding to your email. Incorrect again. The journal is owned by the ACR, not Elsevier. By contract, I have he responsibility for all editorial actions.
5. While I agree with you that it should have been easy for a knowledgeable person to spot Dr. Guiberteau's failure to disclose, I take issue with your implication that we turned a blind eye. It has not been part of the JACR staff routine (nor mine) to review COI disclosures. Perhaps we need to take another look at this issue. In this case, as in most others, it is wrong-headed to attribute to conspiracy what is better explained by simple human error.

Again, I appreciate your interest in JACR and trust that this email concludes the matter.

Bruce J. Hillman, MD
Editor-in-Chief, JACR

In response: 
Dear Dr Hillman:
1) Nowhere in that paragraph do I even see the words "non-responsive".  On The 25th you simply stated "Unfortunately, I found it to filled with unsupported assertions and accusatory language to consider it appropriate for publication. "  
While the message of the letter appeared unwanted by you,  I asked (to absolve any real issues)  what you would like referenced and I would be happy to provide such. I also indicated that the truth is not kind to those who obfuscate and there have been significant problems with these boards. You simply further stated "By no means did I intend to impugn your expertise in this area, which quite clearly is extensive. However, my initial editorial decision stands."
I followed that you had no interest in further pursuit in any information I might add  on the issues propagated upon physicians by the ABMS and ABIM through the other 23 affiliates including Radiology

2) This is not my first Rodeo with the boards, which espouse great amounts of corporate agenda as simple business practice. I am exposing this sort of lack of ethical declaration because it is WIDESPREAD and found only with the ABMS Boards who somehow feel they are magically without conflicts in selling their useless products in an extortive manner and without disclosure.  I did send you this link (  where you could read:
"For example, in two back-to-back articles in the Journal of the American Board of Family Medicine (JABFM), 24,25 one author who contributed to both papers failed to consistently declare conflicts, while another, James C. Puffer, is also executive editor of the journal. Despite the statement, “Conflicts of interest: none declared,”24 Puffer earns more than $600,000 per year as chief editor of JABFP and president and chief executive officer of the ABFM, according to IRS documents. ABMS funds journal supplements promoting its proprietary products, BC and MOC programs,26,27 spending as much as $50,000 per issue. See, for example, the 66-page Fall 2013 supplement to the Journal of Continuing Education in the Health Professions. Recently, the National Quality Forum (NQF), with a long history of American Board of Internal Medicine (ABIM) leadership interactions and personnel exchanges, has been involved in questionable conflicts of interest, leading to congressional investigation and strong allegations of misconduct by an NQF official and inadequate policy to prevent conflicts.28,29"

Dr Puffer is also CEO of the ABFP, Chief editor of the JABFP, senior author of the article espousing the benefits of certification, earns over $600,000 a year and yet has "no COI to declare". Does this amaze you too? See:
24. Schulte BM, Mannino DM, Royal KD, Brown SL, Peterson LE, Puffer JC. Community size and organization of practice predict family physician recertification success. J Am Board Fam Med 2014:27:383-390.  
It is freely available on the web at: because this journal is the property of that ABFP CORPORATION.

3) Normally one might consider Dr Jha's article is quite balanced on it's own. I certainly did. However because of the close link of income from MOC for both the boards and associated national societies which support YOUR journal and so many other close associations, there is apparently a continued need by these societies and their editorial staff to support the corporate structure of these corporations and always find opportunity to pair their viewpoint whenever a contrary view is expressed. These boards have in my opinion outlived any usefulness. 
The fact that  YOU knew both of the authors personally, would seem to support that you knew they were executive board members-which is why YOU asked them to protect the ABR ABMS interests in the face of this balanced, yet corporate embarrassing document from Dr. Jha.  As such, you are your journal's highest representative and ignored the obvious.  Jumping to number 

5) As you Knew these individual and obviously sought them out as representatives of the Corporations they serve, perhaps your choice was "two eyes open" rather than "I take issue with your implication that we turned a blind eye." Certainly you none the less read and approved this statement: "While the opinions offered in this article are the expression of the authors, the document was reviewed and is supported by the Board of Trustees of the American Board of Radiology." As well as recognize this as an ABR corporate email account?

As for Point #4, I refer to the example of Dr Puffer above and clearly recognize that editors and editorial staffs will still have collaboration with the Board Corporate interests. Not all publishers will, like Elsevier, even uphold these important interests regarding the international accepted COI standards. I recognize that would your journal have been directly published without oversight by a professional and acclaimed publisher like Elsevier, we would not be communicating at this point.

In conclusion, I am more than willing to write again an acceptable article or letter for your journal on these important issues, however feel a lack of interest for such on your behalf would require a written request at this time. 
Yes, I do have significant insight I could share with your readership and will be happy to work with you, should you send to me your request.
This is a very important topic of great interest to your readership. 

Thanks again for your time,


Paul Kempen, MD, PhD

Tuesday, June 16, 2015

Regarding the ABR and point counterpoint article and frank ABR support by the College

Here is the 500 word submission:
The recent Point-counterpoint articles on Maintenance of Certification (MOC) provide valuable information, especially both sides conceding that inadequate documentation of the value or validity of MOC exists. (1,2) This extends to the Board Certification ritual itself. Certification arose decades ago, before the multiple levels of regulatory control and capture evolved to provide effective oversight, making this process superfluous in 2015. (3) Several other matters of importance were inadequately stressed:
1) If MOC truly had universal value, it would be apparent and demanded by physicians. The “Boards” have had decades, repeatedly attempting to prove “certification matters” and have failed in spite of repeatedly publishing biased papers “supporting” their position and openly admitted it. (4)
2)MOC can be easily tested by taking 100 physicians each from Australia, England and Singapore and subjecting them to MOC, insuring that they get copies of the test questions they FAIL and requiring them to assess the validity of the questions on an international scale of truth. This is something that US physicians should have been afforded for decades, if learning and improvement were real issues for the ABMS. Cohort them to 100 non-MOC physicians and independently evaluate them by THEIR national standards. This test will never be done, because the boards have no interest in proving the lack of value-although with over $400 million in gross receipts each year and free access to this “product”, they clearly have ample ability to do so.
3) Everyone must realize that the counterpoint article and the referenced “Gallop poll” both are corporate products of the ABIM and extremely biased, if not specifically authored with corporate oversight. A quick PubMEd search shows over 20 such redundant and at times plagiaristic publications of proMOC articles by the authors in this past decade. The Gallop pole was funded, designed and marketed by ABIM. (5) “In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias in the findings of opinion polls.” was acknowledged and question construction/methods specifically facilitate ABIM desired (biased) conclusions:
a) There is obvious transformation of high opinion rates that doctors should be evaluated by MOC: The fact that multiple other methods of evaluation exist is purposely disregarded and obfuscated there.
b) While 2/3 of opinions suggest demand for certification (implied ABMS) and indicate patients would change if doctor was not certified-only 1/3 of patients actually checked. This reflects discordance in realities.
c) The public can want anything that they do not finance. Everyone wants complete healthcare coverage for NO copay and preferably no premium. This is a very similar reality regarding this certification issue, while missing the reality that MOC takes doctors from patients at great cost and NO proven benefits:
The ABIM is the mother of Choosing Wisely-demanding proof of testing value in medical care-yet the hypocrisy of supporting THEIR brand of useless testing without proof of validity or value, screams of self-serving Regulatory Capture agenda. Regulatory oversight must be introduced upon “The Boards” -doctors already have multiple layers!
1) Guiberteau MJ, Becker GJ. Counterpoint: maintenance of certification: focus on physician concerns. J Am Coll Radiol. 2015 May;12(5):434-7.
2) Jha S: Point: twin dogmas of maintenance of certification. J Am Coll Radiol. 2015 May;12(5):430-3. doi: 10.1016/j.jacr.2014.10.011.
3) Kempen PM: Maintenance of Certification (MOC), Maintenance of Licensure (MOL), and Continuing Medical Education (CME):the Regulatory Capture of Medicine. Journal of American Physicians and Surgeons 2012;17:72-5.
4) Kempen PM: Maintenance of Certification -important and to whom? Journal of Community Hospital Internal Medicine Perspectives, Issue 1, 2013 Pages 1-4
5) The Gallup Organization. Awareness of and attitudes toward board-certification of physicians. Available at: Accessed June 11, 2015.

And here is the reply after the rejection was firm:
Thank you for your prompt reply. I do wish to point out to you that Dr. Milton J. Guiberteau, MD, assumed presidency of the American Board of Radiology effective July 1, 2014, as is indicated in the attached announcement (see: This may be common knowledge to you and many but not all of your readers, which thus would demand declaration of COI. It should not be left to assume everyone would recognize his email address as indicative of being the president or employee of the ABR-which he is and this explains his repetitive publishing of PRO MOC articles over the past decade.
As the Journal of the American College of Radiology is an Elsevier publishing Journal and Elsevier publishing states a commitment to
insuring highest ethical standards and eliminating COI in publications. The publisher's own Webpage states (at “The most obvious COI are financial relationships such as: direct: employment…” and states a “duty” of publisher and authors is to declare all real “and potential” conflicts.
The recent article reporting, I wish to point out that this would be a definite conflict of interest and that the disclosure I read at the bottom was as follows and did NOT indicate that Dr Guiberteau is the president of the ABR at the time of submission- a very definite conflict of interests:
"While the opinions offered in this article are the expression of the authors, the document was reviewed and is supported by the Board
of Trustees of the American Board of Radiology.
Milton J. Guiberteau, MD, is from the Baylor College of Medicine, Houston, Texas. Gary J. Becker, MD, is from the American
Board of Medical Specialties, Tucson, Arizona.
Milton J. Guiberteau, MD: Baylor College of Medicine, One Baylor Plaza, MS 360, Texas Medical Center, Houston, TX 77030;
Was there any purposeful intention to obfuscate this suppressed COI, and will you be issuing a clarification to this effect? Clearly, there is a great deal of active support of the various boards by specialty Journals, including the ABR. I would be happy to address to you a letter for publication regarding this COI declaration failure, should this be useful.
Please see the attached notice and my recent article regarding this very issue published in another Elsevier publishing Journal depicting very possibly exactly the same circumstances.

Pro-Con MOC articles in Radiology Journal-time to fight and notice the failure to declare conflicts of interest-rather supporting them as specialty Journal!

These two articles appeared in J Am Coll Radiol. This first one is quite on the mark but reserved in the stance against MOC:
2015 May;12(5):430-3. doi: 10.1016/j.jacr.2014.10.011. Epub 2015 Feb 26.Point: twin dogmas of maintenance of certification.Jha S.

A counterpoint followed on the next page.  I hope radiologists might take this to issue with the editor. The opposition piece was directly from the ABR and ABMS staff and playbook. Of course I wrote a letter to the editor and noticed the fact that there is no declaration of conflicts of interests about the ABR staff member (MJG) writing this piece (beyond his Email address at the ABR!)-pointing again that these specialty Journals are in Bed with the Boards big time.
(Disclaimer from the JACR):
"While the opinions offered in this article are the expression of the authors, the document was reviewed and is supported by the Board of Trustees of the American Board of Radiology.
Milton J. Guiberteau, MD, is from the Baylor College of Medicine, Houston, Texas. Gary J. Becker, MD, is from the American Board of Medical Specialties, Tucson, Arizona.
Milton J. Guiberteau, MD: Baylor College of Medicine, One Baylor Plaza, MS 360, Texas Medical Center, Houston, TX 77030; e-mail:
I will publish my submission here in a week unless I hear back from the Editor Bruce Hillman, MD
Editor in Chief. Here is the communications we have had to date:
-------------------------------Ms. No. JACR-D-15-00254
Important issues missed in the MOC debate-Point/Counter point.
The Journal of the American College of Radiology

Dear Dr. Paul Kempen,

I read your letter. Unfortunately, I found it to filled with unsupported assertions and accusatory language to consider it appropriate for publication.

I am sorry for this outcome, in part, because I am sympathetic with the thrust of your ideas. Thank you for giving us the opportunity to consider your work.


Bruce Hillman, MD
Editor in Chief
The Journal of the American College of Radiology
My reply:
Dear Dr Hillman:
I am not sure you know my history or bothered to read either of my references (I have attached them for you here and the 2014 would clarify matters for you). I have been studying this MOC issue for 6 years intensely, am exquisitely informed of both pro and con opinions  and am happy to provide references for anything you feel needs to be referenced in such a letter, should you only let me know what needs such referencing (Given 500 words and typically 5 references for any letter-my limitations are quite obvious including the need to "get to the point" without flowers). I spent 10 years in Europe and there is NO ABMS MOC in Europe and yet excellence is clearly documented there!  As for the accusatory language (word count limits style) , it is fact that the ABIM paid for the "Gallop poll" (which was never published in any medical journal simply BECAUSE it is not any more scientific than a Pepsi or Coke "taste test") and this keeps popping up as ABIM and ABMS  references- as the starting point for supporting the whole MOC program.  Never is mentioned that State Medical, hospital Boards exist as physician led organizations and have actual authority to intervene in substandard care, while DEA, State, and local police, National data banks, FSMB, etc furthe "regulate doctors along with Tort lawyers.  
Certification/MOC are designed to be much more than minimum standards and  are not "voluntary" should you believe Dr Baron. It has become time to "call MOC" to the carpet and similarly the whole Certification industry and it's illusion-as is happening on the internet and now also Newsweek.  Yes, ABMS has admitted they "got it wrong" only after stark confrontation by physicians like myself threatened their machine-and please be aware that ABIM has been the driving force in this matter via ABMS, pushing through "sign up for MOC or lose the franchise" upon all 23 other boards. I do not think the Radiology boards are necessarily as radically pushing this, much like anesthesia was forced into this and now have,  along with the national societies (ASA) seen the income it generates- the $400 million a year to the ABMS boards is much less than the national societies are making!I will not go on further here, but hopefully await any editorial revision suggestions you might have to make this either acceptable for publication as a letter or otherwise. If you are interested, yes, "the Boards" have an army of people publishing yearly "updates", grandfather attestations and other programs to sell MOC, typically including free advertisements in journals they and national societies own, without providing "equal time" for counterpoint. You can read in depth about this at: . and read more examples of this in this supplement financed to the tune of $50k by ABMS (as per the editor himself in personal conversations) to promote the ABMS programs: . Nora LM. Professionalism, career-long assessment, and the American Board of Medical Specialties’ Maintenance of Certification: An introduction to this special supplement. J Contin Educ Health Prof 2013;33(S1):S5–S6. 
 Also find attached the newest information regarding ABA's own problem with declaring corporate products "Insuring clear declaration of corporate conflicts of interest in all medical journals: the highest priority". I admire your publication of Dr Jha's article and yet wonder why you were unable to select someone who is NOT from the boards to provide an unbiased counterpoint and without the repeated use of corporate products (gallop poll)  as "evidence". Why should any journal continue to provide free advertising to a corporate entity-this would not be done for any pharmaceutical or medical device company, yet alone the extreme extent provided the boards.I look forward to your response.

Paul Kempen, MD, PhD
ABA Board Certified Anesthesiologist 1989, 2005 and never again.

Kempen PM: Maintenance of Certification and Licensure: Regulatory Capture of Medicine. Anesth Analg. 2014 Jun;118(6):1378-86.

P Kempen:  Maintenance of Certification: Ethics and Conflicts of Interest  Journal of American Physicians and Surgeons Volume 19 Number 2 Summer 2014

Friday, June 12, 2015

JAMA issue 5/12/15: Professionalism and Governance: Pure BS

I tried to rebut the propaganda published here and the editors again reject as damage control:
The JAMA issue from May 12, 2015, was a theme issue entitled: Professionalism and Governance,  proclaiming to be a “series of Viewpoints by scholars and academic leaders “.(1) The issue appears to be a clear attempt at damage control, in the face of mounting physician dissatisfaction with “top down” imposition of corporate certification and regulation agendas upon practicing physicians and patients- and now mainstream media reporting of this ordeal in Newsweek. Overwhelmingly representatives from multiple“ legacy” non-profit corporations,  who together built these intertwined industries (including the AMA as “Stakeholders”) with multimillion corporate annual incomes,  again opined how to “fix” education, certification, regulation, etc, of the medical profession to meet their needs as private interest groups,(earning from impositions on practicing physicians and pushing their corporate agendas and outdated testing programs). (2) While both ABMS and ABIM have repeatedly found opportunity to publish their message in multiple journals and internet sites (often owned by the boards) and at times after buying complete “supplements” in medical journals for this purpose and hiding the significant conflicts of interest involved, JAMA now felt obligated to endorse them with yet another free opportunity to facilitate this regulatory capture of medicine.( 3) Opposition has successfully availed social media in grassroots fashion and against overwhelming odds, in spite of limited consideration by the JAMA or the AMA-even from within. Over 17 state medical societies have repeatedly passed resolutions along with the Young physician’s AMA component mounting resolutions at the annual AMA meetings in recent years. Yet respected and authoritative practicing physician opponents of regulatory capture  are remarkable by their absence in this “balanced presentation” of JAMA, including and to name only a few-Drs Wes Fisher ( ), Ron Benbassat ( ),  Charles Cutler (PA Medical Society debate- ), Richard Amerling (AAPS lawsuit against ABMS ) and William Carbone (CEO of the certification agency ABPS
Practicing physicians have become the weakest component driving healthcare policy, with government, pharmacy, university, insurance, computer-EMR, hospital, medical devices and many ancillary industries and professionals dictating practice parameters often over patient prerogatives using their multimillion corporate profits. Physicians increasingly become mere “employees” or are replaced by non-physicians as less educated “providers”-physicians being controlled, not controlling medicine.  This may specifically be the demise of the trust patients extend to physicians. We are losing self-regulation to numerous corporate and government entities and agendas! (4)
MOC and Board Certification are both apparently imposed without relevant data or proof of value, the costs are now forced upon physicians removed from the clinical care and their families, to do whatever outside private interest corporations and government decide must be performed for compliance. (5) Compliance is NOT education!  Past failures serve as anecdotal  opportunity,  to evoke emotion via press reports of serial murder (Dr. Harold Shipman) or hospital mismanagement (Bristol, England)  to facilitate regulatory corporate program growth appeasing political needs-while not addressing any specific problem with recertification. (6)
We only need ONE oversight organization with teeth (state medical boards), which licenses practitioners as physician led organizations and without corporate profit incentives, not the current multitude of independent and profiteering corporations with self- enriching intentions.(1) EJ Emmanuel summarized the problem in this sentence: “ The threat of money to the ideals of medicine is not new.” It is time to cut waste by eliminating the multiple redundant “non-profit corporations” reaching into the medical pocketbook (providing six and seven figure incomes to their CEOS) and specifically providing NO improvement in care. We need to expand Ronald Reagan’s greatest fear “I am from the government and am here to help!”  to include these armies of the non-productive “non-profit organizations” and now stand up for medicine as practicing  professionals.
If medical care is a “right”,  then medical education should be provided by the government at no cost-to reach everyone and without corporate funding influence or  repeated “unfunded mandates”. The negative commercial influence of medical industries as CME sponsors is thus renounced.  Currently,  the intrinsic earnings and conflicts of interests of “accreditation industry giants” (ABMS, FSMB, ACCME, ACGME) are completely ignored as if they were benevolent or producing some unidentified improvement in care. (3) There really is no difference in profit vs non-profit corporations or hospitals, when the price is high and staff earnings so outrageous! To see the CEO of the Pediatrics board earing $1.3 million a year,  while the board itself earns $2 million,  raises significant questions regarding the legality of  “non-profit” status and inappropriate  inurement to select individuals.  The NBPAS is emerging as a real competitor to ABMS,  with no salaries for their executive leaders!
Dr Nisson correctly stated private practice physicians are at disadvantage from universities-they have no universal access to medical literature on any computer. (7) Legislation forcing medical  information  become freely publicly available for anything listed in PubMED/the US National Library of Medicine after 6-12 months is appropriate. Let everyone read the whole articled and not just the excerpt, thus enabling a complete understanding of published “science”,  which only in this way becomes possible,  rather than hidden behind an often self-serving  “conclusion” of the author disseminated as fact in the excerpt. Break the corporate bonds of information dissemination and reduce the number of private profit publishers producing mountains of hubris. The internet makes information readily available, while requiring payment of $25-50 for a single article view (of material already typically privately funded and submitted for free to the publisher),  sight unseen (or based on authors biased excerpt conclusions),  does not!
Finally, let all CME providers,  including MOC products,  compete on an even playing field (possible only with the return to universal lifelong certification as is found in every other industry and was originally intended) with physicians choosing what they deem meaningful learning to them and for their patients and practice. Let competition provide for growth of quality-the good old American way.  It is completely germane to apply the “choosing Wisely” approach of the ABIM to board certification and MOC and recognize this as one of the most wasteful tests of all-false positive “failures”  limiting practice, by pushing good physicians from practice at a time of shortage-and profiting only the ABIM and their affiliates. This hypocrisy of the ABIM to continue with their recertification  program is unbearable.  Eliminate the multiple oversight corporations earning millions via regulatory capture of medicine. (4) Electronic databases mandated by the federal government should increasingly allow for widespread evaluation of practice-make that work…. not physicians doing ever more useless and non-clinical busywork at such wasteful cost. It is time to abandon the certification industry of the past century and move forward using the extremely expensive EMR and insurance based analysis,  also being increasingly imposed at this time. Let all doctors treat patients with their valuable time and let those bureaucrats  demanding the evidence,  find and prove their programs with outcome based data first-the gold standard of medical science!