I’m not ashamed of my CME

The hue and cry against pharmaceutical industry support for CME is growing louder. The latest salvo comes from Merrill Goozner in a post entitled The Shame of CME. (H/T to Kevin MD). Goozner cites a recent JAMA commentary critical of industry funding.

The JAMA piece notes increased commercial support for CME, jumping from $302 million to $1.2 billion between 1998 and 2006. But that’s not the whole story. According to a recent report in Medical Marketing and Media a downward trend began in 2003 along with a similar decline in the portion of educational monies spent on accredited activities, from 75% to 50%. It reflects increasingly onerous compliance standards that must be met for accredited CME funding. As detailed in the report, drug companies now have firewalls in place to help separate educational and marketing activities.

Nevertheless the JAMA opinion writer finds the current state of CME funding “at best very troubling” and Goozner believes states should ban accreditation of industry supported CME if the situation continues.

Why all the fuss? The argument goes something like this: Drug company support for CME is an extension of marketing and promotion. It has to be because the companies wouldn’t do it if it didn’t work. The drug companies influence the content of the CME, rendering it biased and unreliable. The only solution is for industry support to go away.

This popular and well worn argument seems appealing but on close examination is specious. Can drug companies spend large amounts of money on educational material and not influence content? Yes, they can and do. One of the best examples is MerckMedicus, a web site sponsored by Merck & Co., offering doctors free and unlimited access to the full text of dozens of journals and textbooks including Harrison’s, Cecil’s and Ferri’s Clinical Advisor. The site is pristine, with no advertising and no content other than that of the journals and textbooks in their original form. What’s in it for Merck if they don’t advertise on the site or influence its content? Good will, perhaps. Whatever the case, they’ve been offering it for years.

Critics of industry supported CME love to point to the free drug company lunches and evening speakers over dinner at expensive restaurants. I agree that type of activity is of little educational value, but it’s not at issue here because such events are seldom accredited. Those and other questionable sponsored activities may increase, though, if industry is banned from supporting accredited programs. According to the Medical Marketing and Media report cited above the trend may already be in that direction, with non-accredited funding jumping from 25% to 50%.

What about industry support of educational meetings sponsored by reputable professional societies such as the American College of Physicians, the American College of Cardiology and the Society of Hospital Medicine? While most of us believe those courses to be scientifically rigorous, a vocal minority seeks to ban their accreditation as long as they receive industry support. Their innuendo about such activities being only an extension of marketing appeals to public fear but not to evidence, because there isn’t any. Not a shred.

I had to chuckle at Robert Steinbrook’s conclusion in the JAMA piece: “Although eliminating support from pharmaceutical and medical device companies would involve more change than the alternatives, this approach will likely allow the medical profession to control its own continuing education.” Now how does he figure that? Cutting off industry funding would force many CME offerings out of existence and make others much more expensive, thus reducing doctors’ options. How is that supposed to give doctors more control? I don’t think this is what the rank and file of the medical profession want. They remain silent, perhaps because they don’t know what’s at stake. As the Medical Marketing and Media report pointed out, “For continuing education to continue, commercial funding must remain healthy. The future of CME depends on it.”