Industry-supported CME offers potential for bias, study says

Most physicians believe continuing medical education courses funded by pharmaceutical or medical device companies are likely to be biased, but few want to see such commercial support eliminated, a study says.

Nearly 90% of 770 physicians and other health professionals surveyed said commercial support for CME introduces the potential for bias, but 42% were willing to pay higher registration fees to decrease or eliminate such funding. Only 15% said they would do away with commercially supported CME, according to the study in the May 9 issue of Archives of Internal Medicine.

"Many of us are concerned about the impact of industry on the practice of medicine," said Jeffrey A. Tabas, MD, lead study author and emergency medicine professor at the University of California, San Francisco, School of Medicine.

Scrutiny of commercial interests in CME has intensified in recent years. Several organizations, including the American Medical Association and the Assn. of American Medical Colleges, have called for controls on industry CME funding.

AMA policy says industry funding for CME is acceptable only if conflicts of interest are disclosed and if it does not determine course content. The AAMC recommends that institutions establish a central CME office to ensure programs comply with standards set by the Accreditation Council for Continuing Medical Education.

There are about 2,300 accredited CME providers nationwide. Of those, about two in five reported taking no commercial support in 2009. Two in three took commercial support for 20% or less of their total income.

The ACCME has had standards in place to prevent industry influence and bias in CME since 1992, but they aren't mentioned in the study, said Murray Kopelow, MD, chief executive of ACCME.

"The study subjects do not seem to know about the internal controls that are in place to regulate the commercial support of CME," he said. "As a result, it appears that the study validates the need for the existing internal controls, because the respondents believe there is the potential for bias in commercially supported CME."

To help reduce such perceptions, the CME community should do more to educate health professionals about the safeguards, Dr. Kopelow said.

An ongoing debate

Despite widespread discussion in recent years about reducing commercial influence in CME, little research has been done examining the attitudes of health professionals regarding such changes, said Dr. Tabas, director of innovations and outcomes for UCSF's CME office.

The survey was conducted at CME events in five cities between February and May 2009.

The greater the proportion of commercial support for a CME program, the greater the potential for bias, respondents said. Those who reported the highest potential for bias were more willing to pay to reduce the need for such support. Even so, 56% of 370 physicians said commercial support is essential for CME and shouldn't be eliminated. The survey also found that 85% of health professionals significantly underestimate the costs of putting on a CME program.

The study fails to note that commercial support for CME has significantly declined in recent years, from 47.5% in 2007 to 39% in 2009, according to the Assn. of Clinical Researchers and Educators, which supports relationships with industry. Commercial support for CME is beneficial because it provides greater access to programs in more areas, better resources, access to experts and faster access to information on new medications, treatments and medical devices, the ACRE said in a statement.

"The financial help for CME provides the resources for many of the best courses on lifesaving treatments," the ACRE said.

To reduce potential bias, the CME community needs to explore alternative funding and program models, said Todd Dorman, MD, associate dean and director of CME at Johns Hopkins School of Medicine in Baltimore, and Dr. Ivan L. Silver, vice dean of continuing education at the University of Toronto, Faculty of Medicine, in a commentary that ran with the study. "Increased transparency so learners understood the processes the provider used to meet ACCME accreditation requirements would be helpful," they said.