Can you imagine if the rest of the world were to be held to the same standards of disclosure that the CME community is held to? What if, say, members of the Senate Finance Committee had to disclose all ties they have to any companies that could be affected by laws they promulgate, and resolve any conflicts of interest? What if those laws had to be analyzed to determine if any pork, er, bias had crept in, and if it was detected, remedied? What would the results be if John Q. Public were asked to provide an evaluation of the perception of bias detected in any piece of legislation that was proposed? Would anything pass the sniff test? And yet that's what we ask of CME.
Sure, it would be great to live in a world where there is no quid pro quo, docs line up to pay for their own CME, and bias refers just to a diagonal line across a piece of fabric, but even I am not so naïve as to think that world will ever be Planet Earth. But I do think accredited CME is doing a good job of providing fair and balanced education in what can often be an unfair and unbalanced world. And now we're getting some data to back that up.
First was a study published last year in The American Journal of Medicine evaluating the perception of bias in activities put on by Medscape.com, an Accreditation Council for CME-accredited online CME provider. Fewer than 1 percent of the more than 1 million physicians who participated in Medscape's online CME activities during the study period reported bias, and they didn't detect much of a difference, bias-wise, between commercially supported and non-commercially supported activities.
Next came two reports published in the January issue of Academic Medicine. One outlined a study Cleveland Clinic undertook of 95,000-plus CME participants to discover their levels of perceived bias in the 346 CME activities it provided in 2007. The accredited provider found a mean of 98 percent of its participants also found no discernible bias in the activities they participated in, and no significant difference in the bias detected based on how the activity was funded. The other looked at the perception of bias in 213 directly sponsored live CME activities organized by the University of California, San Francisco, Office of Continuing Medical Education from 2005 to 2007, with similar results.
And yet, as Stephen Lewis points out in his column, there are still many who just won't believe it's possible to have fair and balanced education that is underwritten by the pharmaceutical or medical device industry. I'm not one of them. When strictly adhered to and monitored, the current Accreditation Council for CME's Standards for Commercial Support safeguard CME pretty well from the potential for bias. It's gratifying to see the evidence backing up that belief beginning to mount, and I hear that more research is under way to see if the recent results can be generalized to other provider types. I hope these do come to fruition — the more data we can amass, the better we can get on with the business of providing unbiased CME.