Monday, February 23, 2009

Marketing Surveys and the Politics of CME

Recently, this survey of physician opinions about industry funding of CME has been circulating through various blogs and listservs. The lead paragraph will give you a flavor of who stands to benefit from the results:

NEW YORK, NY – January 27, 2009 – A study by healthcare market research firm Manhattan Research found that only 9% of U.S. physicians oppose commercial support for continuing medical education (CME) funding. The results of this study are relevant to the ongoing discussion in the medical community about the role of commercial funding of CME.

The results have been accepted at face value by various stakeholders in the commercial CME industry, but I was skeptical, because the survey was neither published nor peer reviewed, and the press release did not describe the survey’s methodology.

The surveys results were at odds with the most methodology sound CME survey in the literature, which was published in the American Journal Medicine. This study, conducted at the Mayo Clinic, clearly described their sampling procedures and spelled out all relevant demographics. Two different groups of physicians were sampled, those who were attending an industry-supported CME course, and those were attending a non-supported course. Most doctors who attended the non-supported course believed that industry-supported CME is biased (52.7% answered “yes,” 37.6% answered “no”). On the other hand, doctors attending the industry supported symposia tended to believe that they are not biased (24.3% "yes," 63.7% "no").

The bottom line of this survey is that opinions about commercial support of CME depend entirely upon which physicians you sample. If you choose to sample doctors who are in the midst of a free conference with the nicest meals, the flashiest slides and the biggest names that industry money will buy, they will defend the wisdom of their choice. But if you sample physicians who choose to pay for their own medical education, you will find that doctors overwhelmingly reject industry funding of CME.

Which physcians did Manhattan Research sample? I asked Mark Bard, president of Manhattan Research, who wrote me that: “The physician sample was a nationally (US) representative mix of primary care and specialists (total of 904 physician respondents) and reflective of national norms for age, gender, region, and practice setting.
Although the survey was completed online, they were recruited by phone, fax, and email (to the panel).”

I’ve asked him the crucial question of how this particular sample was identified, but I have yet to receive an answer.

On its website, Manhattan Research
describes itself as “a pharmaceutical and healthcare market research and services firm that helps healthcare and life sciences organizations adapt, prosper and explore opportunities in the networked economy.” Their client list includes 11 drug companies (including Pfizer, GlaxoSmithKline, Johnson and Johnson, Abbott, and Wyeth) and two giants in the medical education industry (WebMD, owner of Medscape, and Elsevier).

I find it sad, though quite revealing, that the CME industry has found it necessary to latch onto this non-peer reviewed survey in order to further its political aims.


Steven Reidbord MD said...

While I wouldn't call 53% to 38% an "overwhelming rejection," your point is otherwise sound. It's so easy to mislead with statistics, especially with biased samples.

On a happier note, nearly a quarter of US physicians now refuse to see pharm reps in the office:
This is much higher than I would have guessed. The times, they are a'changing.

Anonymous said...

Maybe as a generalization to why we have this mess with CMEs/pharma/rogue colleagues, I offer a column I read today in the Baltimore Sun:,0,4698249.story, a piece by Douglas MacKinnon about entitlement. Puts both his take about culture and to me about psychiatry perfectly.

Entitled. Yes, you are entitled to a physician giving you as the patient the best care he/she has been trained to provide for the diagnosis you present. It is about medication, self exploration, and change. Any readers who are focused on a biochemical imbalance model, just keep reading the pharma ads in magazines and on TV. Don't come to me!


Robert W Donnell said...

Dr. Carlat,
What free CME courses were you talking about that were addressed in the Mayo study? I checked the Mayo CME web site. All of the courses in question, both industry supported and non-supported, are expensive, at around $700-$1000 a whack. So please enlighten me as to what this paper had to do with free stuff.

The survey respondents, including the attendees of industry supported courses (they Mayo ones, even the supported offerings, are very expensive) represent a relatively select group of doctors who are willing to pay considerable sums of money for their education.