The Wall of Commercial Bias Keeps Crumbling Down

It's rare for an industry-friendly magazine like Medical Meetings to feature an article opposed to commercially-sponsored CME. And rarer still for the editor-in-chief to preface the issue with an editorial in support of this position. But we are seeing a historic sea change in public opinion, and the unpredictable is becoming commonplace.

First, read Tamar Hosansky's editorial, Fast-Track CME Reform. In it, she discusses the recent annual conference of the Alliance for CME, a trade group that supports commercial CME. After mentioning another trade group's announcement that it will start collecting data to audit bias in commercial CME (calling all hens--leave henhouse immediately!), Hosansky states her own opinion: "First, I believe the move toward curtailing commercial support is inevitable." Hardly naive, Hosansky appreciates "CME providers' reluctance to limit funding. But it's only by making fundamental changes to the financial and accreditation enforcement models that the CME community will begin to establish its credibility and reduce the threat of government regulation."

But the jewel of this issue comes later on, in Donna Beales' article entitled "5 Steps to Building Real Firewalls." Beales is the CME Coordinator at Lowell General Hospital in Massachusetts. It's unusual for a CME professional who stands to benefit from industry funding to take such a strong ethical stance. Or, as Upton Sinclair once said, "It is difficult to get a man to understand something when his job depends on not understanding it."

Beales argues, among other things, that physicians with commercial interests should be ineligible to present CME programs. I'll quote at length from this part of her article, but please go to the original to read the whole thing (I have bolded some passages in the second paragraph; the bolding in the third paragraph is in the original text).

"Increasingly, it's becoming a standard across all industries to disclose commercial interests. On most boards, if an individual has any conflicts, it's expected that he or she will be recused from voting on any issues that might involve personal gain.

Choosing to be a physician is a noble calling. Choosing to be a drug company representative may have lucrative financial returns for a doctor who is burned out with medical practice. Both are free enterprises. It's time to choose between one or the other — teaching, or hawking. They are not one and the same. In fact, education and enterprise are mutually exclusive. It's time for doctors to get back to the business of doctoring, and for those with aspirations toward the world of commerce to depart the profession for greener pastures.

If we're worried that we won't attract anyone to teach due to the lack of financial gain, then it's time to look at the whole structure of CME. No other educational program in the U.S. is free of charge to participants. Perhaps it's time to entertain the possibility that participants themselves should defray some of the increasing costs that will inevitably result from a real split between industry and medical education. Attorneys and accountants often pay for their own continuing education course work. If lawyers can afford to do it and bean counters can afford to do it, surely doctors can manage too."

Sloan-Kettering to Commercial CME: "You're Outta Here!"

Memorial Sloan-Kettering Cancer Center, which is ranked the second best cancer center in the nation by U.S. News and World Report, has just achieved another impressive distinction--it has banned commercial funding of CME throughout the institution. In a fascinating article, Dave Kovaleski of Medical Meetings Magazine describes a process that began in July 2006, when the hospital's physician in chief, Robert Wittes, MD, decided to take this bold action in order to keep medical education "purely educational."

This is an instructive case study of how a large institution can wean itself off industry CME support and end up with a stronger educational program. Thomas Fahey, M.D, who chairs the CME committee, has overseen the transition and says that "I don't think there's any evidence to show that the extra money made CME better." In fact, Fahey feels that the new environment "keeps the focus where it should be--on education--and that comes across to participants."

The hospital had received 25% of its CME budget from industry, and in order to make up the shortfall they "de-fancified" their programs. For example, they shifted conferences from hotels to hospital conference rooms, they stopped paying for physicians' lunches, and they recruited more internal faculty members to speak. Apparently, it is still possible to convince physicians to educate their colleagues without the incentive of a fat check. They also increased the fees physicians must pay for some courses by 10-20%.

And what has been the response? Are physicians boycotting these meetings because they are too cheap to pay for their own education, as many defenders of commercial CME warn is inevitable? No. Attendance has remained steady and there have been no complaints.

Obviously, Sloan-Kettering is a particularly well-funded institution, and it can draw on stellar faculty to give CME, both of which make its industry-free transition smoother than it will be for other hospitals. Nonetheless, it provides a encouraging example of what is possible when the leadership decides that it's time do the right thing.

New Survey: 81% of Doctors See Commercial Bias in CME

In a unique survey of 1200 randomly selected American physicians, Medical Meetings Magazine reports that 81% of respondents perceive at least least some commercial bias in CME programs. You can read the entire article here.

When asked what factors most contributed to commercial bias, the most frequently cited reason was industry funding of the activity, followed closely by the presence of faculty financial relationships with industry.

While these survey results are about as surprising as finding sand at the beach, let's hope that the ACCME and AMA take note, both of which still strongly support industry-funded CME.