Industry support of CME under scrutiny

The majority of attendees at continuing medical education programs said they did not detect any bias in CME courses funded by the pharmaceutical industry, a recent study said.

Attendees at 213 accredited educational programs offered by the University of California, San Francisco, from 2005 to 2007 were surveyed. One-third of the courses had no commercial support, and the remaining courses had varying levels of commercial support, according to the study published in the January Academic Medicine (link).

"Overwhelmingly, the respondents said they thought the events were free of bias," said Michael Steinman, MD, lead author of the study and associate professor of medicine at UCSF.

But even if the physicians in the study didn't detect bias, that doesn't mean it isn't there, he said. "Bias can be very subtle, and it's possible there was bias but participants just couldn't see it. It could be subconscious. We've known for a long time that bias is hard to detect."

Industry support and perceived bias in CME are increasingly coming under scrutiny. Commercial enterprises, mostly drug and device companies, provided $1 billion in 2008, about half of CME funding, according to the Accreditation Council for Continuing Medical Education.

That influx of funds has raised red flags for many observers. The Institute of Medicine last year recommended development of a new system of funding CME that is free of industry influence.

Curbing industry influence

Lewis Morris, chief counsel for the Dept. of Health and Human Services Office of the Inspector General, said industry influence is present in CME. Any research "would merely prove what the empirical evidence already shows us, which is that commercial sponsorship of CME inherently brings bias into presentations," he said.

Industry spending on CME prompted Morris and Julie Taitsman, MD, chief medical officer for the HHS IG Office, to propose ways to limit industry influence. Their recommendations were published in the Dec. 17, 2009, New England Journal of Medicine (link).

Among their suggestions: physicians should pay the full cost of CME, rather than allow industry contributions to subsidize courses. Morris noted that lawyers, accountants and many other professionals paid for their continuing education courses. "It isn't clear to me why physicians shouldn't be held to that same standard."

Dr. Taitsman agreed that requiring physicians to pay their own way "is the direction in which we are moving, and in 10 or 20 years, it will happen." Such an approach would cost each U.S. physician about $1,500 a year.

Murray Kopelow, MD, chief executive of the ACCME, a nonprofit group that develops standards for CME providers, said there are no data to support the perception of biased information. "We are not being provided with data by the public, the profession, industry or other providers that commercial bias resulting from commercial support is prevalent," he said.

The ACCME is continuing to monitor the debate over commercial interests and CME, Dr. Kopelow said.

Previous research has shown that physicians erroneously believe themselves to be impervious to bias, said Howard Brody, MD, PhD, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston.

"Any time this has been studied, it is clear we [physicians] have no insight into the degree to which we are influenced," he said.

The pharmaceutical industry said it has put in place policies intended to address concerns about industry support of CME.

Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, said PhRMA's voluntary policies for its member drug and biotechnology firms specify that funding of CME should support education on a range of treatment options rather than promote a specific medicine. Companies also should separate CME grant-making activities from sales and marketing, according to PhRMA policies.