Physicians have good reason to be leery of industry-sponsored CME

LETTER — Posted Jan. 17, 2005

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Regarding "Voluntary self-regulation of CME sponsorship debated" (Ethics Forum, Dec. 6, 2004): Thank you for that much-needed and thoughtful debate. After nine years of practicing internal medicine and much reflection on the subject, my position has evolved to that of Ethics Forum commentator Arnold S. Relman, MD.

The pharmaceutical industry is in the business of making money, and physicians delude ourselves to think that we can be informed and discriminating consumers of the drug industry.

Recently I attended a local CME event that left me with an uneasy feeling of questioning one of the speaker's motivations. He was a noted specialist from a nearby medical school. He gave what appeared to be an objective discussion of competing drugs A and B. I had to go to a prescribing book afterwards to find out that the event was sponsored by the maker of drug A.

The problem was that the speaker omitted the discussion of the additional therapeutic effect of drug B that made it the better prescribing choice.

As much as I tried to give him the benefit of doubt, the questions kept coming. By appearing even-handed, did he convince himself that he was being objective, or was it a smokescreen to deceive his unsuspecting audience?

Did he make conscious choices to compromise himself for self-gains? I recognized the bias this time, but how much am I missing?

Unfortunately, drug industry-sponsored CMEs lead me to ask such distasteful questions and leave me little confidence in any speaker's perceived self-objectiveness as the sole safeguard against bias for busy practitioners.

I wholeheartedly agree with Dr. Relman and appreciate his wisdom.

Voluntary self-regulation is as flawed as the human beings who hold this responsibility, and we do our profession a disservice by being beholden to the purse strings of the pharmaceutical companies.

Since it doesn't appear that drug industry-sponsored CMEs are on their way out any time soon, I appeal to my esteemed colleagues who speak at these education seminars to be as forthcoming as possible to retain their own credibility and self-respect.

With regard to my own responsibilities, I've been increasingly questioning my rationalizations for participating in these CMEs. They have been easy and free opportunities for keeping up with the latest developments.

I thought I could pick and choose what these CMEs had to offer without compromising my professional integrity, but I might not be picking up all of the subtle biases.

At the least, I will be making even greater efforts to be more discriminating when choosing material for CME, and, ultimately, I know I have the power to reject easy and free CMEs sponsored by the drug industry.

Aeria Chang, MD, La Jolla, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/01/17/edlt0117.htm.

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