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Time for a Reappraisal of the “Business�? of CME

Posted on | February 15, 2008 | No Comments

We should consider continuing medical education in the context of a free economyThe growing criticism of pharmaceutical company funding of CME has rattled both the pharmaceutical industry and many legitimate providers of CME. To recap the recent criticisms:

  1. The Special Communication by leaders of academic medicine in JAMA, the Journal of the American Medical Association (Jan. 25, 2006): “Marketing and market values should not be allowed to undermine physicians’ commitment to their patient’s best interest or to scientific integrity. … Manufacturers should not be permitted to provide support directly or indirectly … to any ACCME [Accreditation Council for CME]-accredited program.”
  2. The Senate Finance Committee report (April 25, 2007): “…various industry groups and government agencies have created guidelines for educational grants to reduce the potential for abuse. Drug companies, however, are not mandated to follow the guidelines and a significant gray area continues to exist regarding the use of educational grants to serve marketing purposes.”
  3. The ACCME (Oct. 12, 2007) redefined a “commercial interest” as “any entity producing, marketing, re-selling or distributing health care goods or services consumed by, or used on, patients,” meaning that if a currently accredited provider is part of an agency that also promotes drug products, even when a firewall exists, the provider must give up its accreditation or dramatically change ownership structure.
  4. The Josiah Macy Jr. Foundation conference report (January 2008): “…commercial entities that manufacture and sell health care products should not provide financial support for the continuing education of health professionals. … Organizations authorized to provide CE should be limited to professional schools … not-for-profit professional societies … organizations accredited by the Joint Commission …”

The implication of these attacks is that banning “commercialism” in CME will remove bias from CME and free physicians from undue influence that now prevents them from following clinical guidelines.  Hogwash!

Certified CME content is the result of input by its faculty, whether supported by industry or not, whether developed by a for-profit medical education company or not. Faculty from an academic medical center or professional society may reflect biases because their research was supported directly or indirectly by industry grants – yet they are the experts in the subject matter. Faculty members may also reflect biases based on institutional pressures or personal experience. There is no evidence that faculty behaves differently if a CME program has no industry support.

Further, regardless of funding source or status of an accredited provider, the faculty and organizers use available evidence to develop content. Evidence is of variable quality. The best often comes from randomized controlled double-blind studies funded by drug manufacturers; at a lower level is evidence from studies based on small samples without adequate controls. The bottom level is expert opinion. The quality of this evidence is unlikely to change if commercial interests are removed from involvement.

Physician learners are not 8-year-olds to be banned from R-rated films. Yet the critics feel that doctors need to be “protected” – presumably from their own inability to judge bias when they see it. Patient care decisions, in our opinion, are unlikely to be better if CME programs are provided only by academic medical centers and specialty societies, paid for by their members/attendees or by government. There is no evidence to support that claim.

Finally, it appears that the critics have forgotten that they themselves are free to be exposed to professional and consumer advertising – and still make intelligent decisions. Perhaps academicians should be prohibited from reading the ads in professional journals – or from watching car ads on TV. Undue influence, you know; they can rely on Consumer Reports guidelines to decide which car to buy. Or which food products, beer or vitamins to ingest. In our free economy, advertising pays for much of what we read, view and hear. And we are free to evaluate the information and make our own decisions. Sometimes, as with doctors, our decisions may affect the health and lives of others. But freedom of information and freedom of commercial support are preferable to mandated controls, so long as the benefits outweigh the risks. Most of the time, the free economy system works.

Why not let it continue to work in CME?

(Lewis A. Miller is corporate editorial director of Dowden Health Media and co-founder and principal of WentzMiller & Associates, a global consulting firm. He can be reached at lew@wentzmiller.org. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)

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