CME and bias: The latest salvo from Marcia Angell

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Marcia Angell, MD, formerly editor-in-chief of the New England Journal of Medicine and a vocal critic of industry-physician collaboration, has a new editorial in the Boston Review outlining how she believes pharma dollars influence healthcare research and education. She says, "Conflicts of interest are ... troubling in medical education, where industry influence is perhaps greatest and least justified. The pharmaceutical industry devotes much, if not most, of its vast marketing budget to what it calls the 'education' of doctors. The reason is obvious: doctors write the prescriptions, so they need to be won over."

She's particularly critical of medical education companies, which she says basically allow pharma companies to provide "marketing masquerading as education." NAAMECC, time to write a rebuttal, don't you think?

She also says that "CME is supposed to be free of drug-company influence, but incredibly these private educators have been accredited to provide CME by the American Medical Association’s Accreditation Committee for Continuing Medical Education—a case of the fox not only guarding the chicken coop, but living inside it."

To which I say, huh? If she means the Accreditation Council for CME, someone should tell her that the AMA doesn't own ACCME; it is just one of seven member organizations (the others being the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards).

And it appears that's all she has to say about rules and regs around CME, since she doesn't mention anything about the Standards for Commercial Support, which exists to rein in exactly the type of industry influence she says CME is rife with, or the ACCME's accreditation criteria, which are designed to ensure that accredited providers offer real education that leads to better healthcare outcomes, not "marketing masquerading as education."

While no one is saying the accreditation process is 100 percent effective at preventing any and all abuse, by totally ignoring the safeguards, I think she undermines her argument considerably (maybe someone can point her towards our CME Rules and Regs page for a refresher. Hmm, and I wonder what she'd have to say about this study that found commercial support didn't result in bias, and in fact found commercially supported CME less biased than that which wasn't underwritten by industry? But I digress.).

Her solution? "[Doctors] should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard." I wonder if she's read this column, which explains why physician education is not comparable to, say, that of lawyers? Not that I necessarily disagree that it would be nice if we could provide what HCPs need in education independently of pharma company support, but nothing I've seen or heard tells me that anyone thinks this is a realistic goal. And it wouldn't eliminate all bias anyway, since I've yet to meet a human who didn't have opinions and worldviews of their own that could sneak into a presentation, even if the person had never taken as much as an aspirin in his or her life, much less owned stock in a drug company, had a cousin who worked in pharma, seen a TV drug commercial...you get the drift.

But it's a very compelling read, with lots of high dudgeon, and she does make some interesting points. Just not in the education piece of it, where I think she simplified her argument too much, glossing over some pretty key things to get where she wanted to go. As any provider knows, everything about CME is very nuanced, and both the problems and the solutions can be found in the details. If she wrote this 20 years ago, perhaps I'd find it more credible. But we've come a long way since then, something which Angell conveniently ignores to score her points.

Other related blog posts:

Boston Review: Boston Unscientific -- Selling Fiction (Thomas Sullivan, Policy and Medicine)

Great New Article by Dr. Angell (Daniel Carlat, MD, The Carlat Psychiatry Blog)

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