I imagine I won't be alone in my reaction that the solutions Donna Beales offers in her article “5 Steps to Building Real Firewalls” (March/April 2008) reflect an overly simplistic view of the CME industry. The suggestion that doctors must choose between teaching or “hawking,” that physicians should disclose their financial interests to patients when prescribing, and warning that “speakers with hidden agendas will slip though the cracks and end up in front of rooms full of unsuspecting physicians” are as ridiculous as they are unrealistic. Physicians understand what bias is, and they take as much professional responsibility for assessing and reporting it as providers do in preventing it. There's room for improvement, and the industry is addressing those issues; we don't need a government agency to do this for us.

I find no fault with the fact that Beales' article was billed as a provocative plan, however, her convenient disregard for a number of standard industry practices that promote fair and nonbiased CME was glaring, as was her limited knowledge of the contributions of medical education and communication companies. For example, she disregarded the practice of effective conflict of interest resolution that puts the vetting of content where it rightfully belongs — with disinterested qualified medical experts — not with medical education directors pretending to be content mediators as she suggested.

Centralized government agencies to police the CME industry are not part of the solution, nor is the promulgation of inflammatory rhetoric that was used throughout Beales' article (“snake oil cart,” “vagaries of sleeping with commercial interests,” “a pediatrician suddenly claiming expertise in podiatry or brain surgery,” etc.). I'm a strong advocate for articulating our weaknesses and generating viable solutions, but we can certainly do so without the drama of expositions that hold more shock value than practice value.
Robin Hendricks, MAdEd
Director of Communications
Londonderry, N.H.

There are several things I could say about Donna Beales' “5 Steps to Building Real Firewalls” (March/April 2008), but I would like to respond specifically to her fifth step: Lobby to make “plain language” disclosure to patients a legal requirement. It appears that Beales assumes that all physicians make clinical decisions based on the benefit to themselves rather than to the patient, and that patients should inherently distrust the recommendations of their physicians because physicians have all been corrupted by drug companies and commerce. In response, I would like to relate the following account of a recent visit to my primary care physician: As I sat in the crowded waiting area of my PCP's office, I noted the arrival of a young man in a dark business suit carrying a briefcase, and I immediately knew him to be a representative of a drug company. My PCP agreed to speak with the man briefly, between patients. Since the office is not very large and the conversation took place in the hallway, I was able to overhear it. The final question the drug rep put to the doctor was, “And what is keeping you from prescribing more of our product?” The response from my doctor was simply, “My brain.”

Perhaps this story will encourage Beales with the thought that drug companies don't have quite as much influence over the clinical decisions of physicians as she thinks.
Annette Schwind
Continuing Education Administrator
Academy for Healthcare Education Inc.
New York

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Related article:
5 steps to building real firewalls