The past few years have seen dozens of articles, reports, and so-called “expert” testimony claiming that continuing medical education activities are biased. The source of this bias? The pharmaceutical companies and other grant funding organizations, of course.
Never mind the evidence, the bias accusers know it when they see it. Trust them.
The concept sounds reliable at first. Pharmaceutical and other organizations with a “commercial interest” must be turning CME content into a commercial somehow. We all know that pharmaceutical advertising is in short supply. And it just wouldn't make sense that drug manufacturers would fund CME so physicians could fully understand scientific advancements and safe practices related to specific therapeutic areas.
The bias accusers have seen the light, and it does not reflect well on CME funding. Never mind that accredited providers have to identify and resolve faculty conflicts of interest. Forget that brand names are forbidden. Pay no attention to content validation requirements or the updated Accreditation Council for CME Standards and policies prohibiting a grant funder's influence over faculty selection or CME content.
The argument remains simple. Bias occurred seven years ago (when many of the current rules separating education from promotion didn't exist), so it must still exist today.
The 2009 Institute of Medicine report, “Conflicts of Interest in Medical Research, Education and Practice,” identified the seemingly pervasive but mysterious concept of “unconscious bias” caused by CME grant-funding.
Apparently, the mere existence of grant-funding is like a drug itself that causes faculty members to lose their minds and promote pharmaceutical companies, even though they are prohibited from doing so by the accredited providers who must approve the content. Perhaps the providers willingly risk losing their accreditation because they also are under the influence of this “grant crack?”
The American Medical Association took it a step further in its 2009 “Report of the Council on Ethical and Judicial Affairs.” The CEJA report stated that grant-funding soiled CME content by creating both “unconscious” and “subtle bias.”
There are two important non sequiturs plaguing these “subtle bias” arguments. First, if CME bias is so subtle that physicians can't detect it, how is it that the authors of these reports can do so?
Second, the evidence cited by CEJA doesn't hold up. The footnotes CEJA provides to support the connection between grant-funding and CME bias don't even relate to CME activities. One article is on “gifts to physicians from industry” from marketing/sales representatives. The second is a Harvard Business Review article on the 2002 Enron scandal and financial crisis addressing “Why Good Accountants Do Bad Audits” (erroneously titled by CEJA as “Why good accountants go bad”).
In spite of mounting evidence and convincing studies showing little or no connection between bias and grant-funded CME, the bias accusers think they know better. They would be wise to reconsider their approach.
Last year, the chair of the Cleveland Clinic Department of Cardiovascular Medicine told the U.S. Senate that “CME has become an insidious vehicle for the aggressive promotion of drugs and medical devices.” In January, the Cleveland Clinic released a comprehensive study of more than 95,000 CME participants showing that 98 percent of these attendees considered CME to be free of bias, whether or not industry grant-funding was provided.
Sooner or later, evidence trumps accusations.
Stephen M. Lewis, MA, CCMEP, is president of Littleton, Colo.-based Global Education Group. He can be reached at slewis@globaleducationgroup.com.
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