Tuesday, June 16, 2015

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: guiberteau@theabr.org.
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: http://www.jpands.org/vol19no3/kempen.pdf . 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 http://www.jpands.org/vol19no3/kempen.pdf

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