Stephen Lewis

Lawyers work for people. Physicians work on people. Lawyers work with laws. Physicians work with human life. Despite the significant differences between lawyers and physicians, the camp of people aiming to eliminate industry support of continuing medical education would like us to think that the justice and healthcare systems are one and the same. We've heard the arguments before: Lawyers often pay for their own continuing education, so why shouldn't physicians?

The comparison between lawyers and physicians is a stretch in any instance. When it comes to the field of certified CME, however, taking action based on this analogy actually would be harmful to public health. Let's take an example and discuss why the lawyer-physician CME argument should not be resuscitated.

Analogical Disconnect

In its 2009 report, Conflict of Interest in Medical Research, Education, and Practice, the Institute of Medicine (with funding from the Josiah Macy, Jr. Foundation) bought into the idea that physicians could pay for certified CME just as lawyers pay for their continuing education.

The IOM report echoed others when it stated, “Although legal continuing education cannot be seen as an exact model for medicine, it does suggest that alternatives to the major role of industry funding for continuing medical education may exist.” But the legal-medical continuing education analogy doesn't make sense for several reasons:

Volume of information: More than 400,000 medical journal articles are published each year, making the practice of medicine much more dynamic than that of law. It may take years to debate and change laws (Social Security reform, anyone?), but scientific advancements occur daily. The sheer volume of new scientific data and changes in medicine demand more, not less, certified CME.

Changes to practice: Medicine involves constant advancement, testing, and application. It features landmark breakthroughs, such as the discovery and testing of new therapeutic agents. The legal system is based on the tradition of stare decisis, or precedent. In short, changes in the law are evolutionary while changes in medicine often are revolutionary.

Mistakes make a difference: A drug used incorrectly is a poison. When a lawyer makes a mistake in practice, parties can appeal to a higher court. A physician's mistake in prescribing medication or on the operating table can mean the death of a patient.

Given the changes in federal regulations and CME accreditation rules that require disclosure, resolution of conflicts, fair balance, and sound science, taking aim at industry funding misses the mark. Independent and relevant education — whether funded by pharmaceutical industry grants, hospital administrators, physician practices, or academic medical center budgets — is good for practitioners and patients alike.

Law and medicine are two different fields with very different needs for continuing education. Even if we agree that physicians should pay more for certified CME, we need to encourage funding support from all sources.

Stephen M. Lewis, MA, CCMEP, is president of Littleton, Colo.-based Global Education Group, and president of the North American Association of Medical Education and Communication Companies. Reach him at slewis@globaleducationgroup.com.