We must recognize that the potential for bias will always exist. Instead of being obsessed with it, let’s focus our energies on developing effective mechanisms for detecting bias.
If you look at the headlines of any CME-related news these days, you'll find that the role of commercial support in CME is being challenged. At the heart of the heated debate is the issue of bias.
Although the Accreditation Council for CME has provided an official definition of commercial bias, there is no guideline for an acceptable level of bias within CME activities. Some have hypothesized that a standard of no bias is not an achievable goal. Perhaps our target should be an undetectable level of bias.
The reality is that preventing bias in one instance may promote bias in another. For example, an activity may present available clinical data evenhandedly, based on the clinical safety and efficacy of a class of agents. The references may be biased in favor of the newer agents since they are more likely to have been discussed in recent publications that are perceived to be more accurate. So where does that leave us?
Focus on Bias Metrics
We must recognize that in our imperfect world, the potential for bias will always exist. Instead of being obsessed with it, let's focus our energies on the critical evaluation of the mechanisms we employ to detect bias. We can start making progress by asking some important questions:
-
Are we using tools that provide an objective measure of the level of bias in our activities? Such tools should assess whether the content was presented in a neutral manner in accordance with the published data. We should also examine whether there was reverse bias due to an overcompensation toward one agent or class of agents to avoid the appearance of favoritism toward a funder's commercial interest.
-
Do we consistently use tools that help us identify and resolve conflicts of interest?
-
And finally, have we ensured that, in our attempts to provide a fair and balanced discussion of the therapeutic options, we have not inadvertently obscured the learning objectives and diluted the intended educational impact?
The North American Association of Medical Education and Communication Companies Inc. has issued a draft code of conduct that lists some tools to detect and minimize bias. (Visit www.naamecc.org to download the code.) It's time for the CME industry to unite — all provider types and those who fund CME — and reach a consensus on this issue. This will allow us to move forward and create, validate, and standardize objective metrics that can be used industrywide. We can then confidently expend our efforts on disseminating education that effects positive change.
Ann C. Lichti, CCMEP, is the vice president of Health Care Education Strategy for Veritas Institute for Medical Education Inc., Hasbrouck Heights, N.J. She has worked in the healthcare industry (both CME/CE and clinical research) for more than six years. Reach her at ann.lichti@veritasime.com.
Harold I. Magazine, PhD, president, Veritas Institute for Medical Education Inc., has a combined 18 years in academic research, publications, and medical education. Reach him at harold.magazine@veritasime.com.
The opinions expressed are those of the authors and do not constitute the views of Veritas Institute for Medical Education Inc.
