Bipolar, sandwiches, CME, and intellectual honesty


Genetics are mostly to blame

For bipolar chemical change

    Despite volume loss

    The amygdala’s boss

Of structures all over the brain.

To maintain licensure and certification, doctors have to complete a certain amount of Continuing Medical Education, or CME.  My state license requires 30 hours, my board certification demands 50.  Most years I stop counting at 200 hours. 

Audio Digest, a subsidiary of the California Medical Association, records CME lectures around the country and provides credentialing for the activity with a pre test and a post test; I listen to one of those lectures a week in the car.

I attended the American Academy of Family Practice Annual Scientific Assembly in Denver last week, and I finished with about 20 hours.  In other courses I’ve walked away with 54 hours in 5 days and an overloaded brain.  I decided to enjoy the lectures this year.

Arcane regulations govern what counts as CME and what doesn’t.  Yesterday, over the noon hour, I went to a lecture about neurophysiology in bipolar disease.  (We used to call bipolar disease manic-depression; people cycle from really high highs to really low lows.  Most of my best friends have been bipolar.)  No CME credits were offered.  I confess that if the lecture hadn’t come with a sandwich I probably wouldn’t have attended.  (On the other hand, CME might have been offered if there weren’t a sandwich.)

A drug company sponsored the talk and bought the food.  I expected biased information about a drug.  I depend on the data from Big Pharmaceutical being biased; certainly a company won’t tell the whole truth about their drug but the competition will fill in the gaps.  Such is the nature of capitalism.

I do not remember the name of the sponsor, and the only drug mentioned, lithium, has been off patent for decades.

The lecturer was dynamic and passionate about bipolar disease.  He does research on the problem using the functional MRI; he showed himself to be quite knowledgeable.  During the lecture, the docs kept turning to each other and saying, “I didn’t know that.”

Every attack of bipolar mania leaves structural changes in the brain; the more attacks one has, the more attacks one gets and the harder stabilization becomes.  Getting the illness to symptom control decreases structural changes but not as much as bringing the disease to remission.  The left amygdala (funny how that brain structure keeps popping up; see my post entitled “Rage, Hunger, Lust, and Sleep”) shrinks in bipolar disease, proportionate to the severity and number of attacks.  While the left amydala loses volume, the activity increases, but the right amygdala doesn’t change.  The centers which govern impulse control change in size and activity, as do a number of other structures.  Treating with lithium, still the most potent bipolar drug, reverses the volume loss changes but not completely.

I find no moral dilemma in accepting food from a pharmaceutical company, as long as I maintain a similar relationship with their competition.  The current ban on small gifts to doctors such as pens and notepads insults the intelligence and integrity of the medical community but it cuts down on the clutter and junk in my office.

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