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: https://www.abim.org/pdf/publications/Gallup_Re.... 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:http://www.theabr.org/sites/all/themes/abr-medi...). 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 (athttp://www.elsevier.com/?a=163717) “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;
e-mail: guiberteau@theabr.org."
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.

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