Dear Editor: Your opening editorial in the September/October 2001 issue ofhas recently come to my attention. I was shocked by the way you related my comments. They were completely out of context. The inference was that I was against the pharmaceutical industry being involved in Continuing Medical Education activities, when in fact I was a strong advocate for the industry's role in the CME process. I emphasized that those of us who are providers of CME activities have to be sensitive to the needs of the pharmaceutical industry.
As we have a responsibility to the physician community, the industry also has a responsibility to their shareholders that their money is being well spent. By and large, the industry, with few exceptions, has accomplished this in an ethical and unbiased manner. However, it is totally unrealistic to even think that a particular company would support a speaker who speaks in a biased manner toward their product.
Without industry support only the larger academic centers would be financially able to support CME activities. Surely this would present an unbalanced view of medicine as practiced in our country. I would further anticipate a considerable reduction in the scope and volume of CME activity, to the detriment of the physician community, and in particular to the public who are the true beneficiaries of CME activities.
Morton Morris, D.O., J.D.
Chairman, Council on CME
American Osteopathic Association
Dear Editor: Reacting to your editorial in the September/October 2001 issue, permit me to offer a hypothetical situation that casts industry's role in CME somewhat differently from your depiction. As written in your “No More Compromises,” page 123, I can envision pharmaceutical product managers reconsidering continued diversion of advertising dollars to CME, because the bar is raised unnecessarily high. Rather than focus on warnings and rare adverse events, let's look at the indications and potential patient benefits from industry's support of CME.
“I've just had an important learning experience,” a primary care practice physician might say following a visiting lecture program supported by Pharma Company X. “And, fortunately, the speaker was a little biased, so that we could learn of his prejudice for or against New Drug Y. Although the speaker was one recommended by Pharma Company X, the CME provider approved [the suggestion], since that speaker was one of the lead investigators in New Drug Y's clinical trials.”
More often, a commercial supporter will offer multiple names for potential, from which the CME provider may make a choice. And [it's] usually a good choice, since it's only logical that the supporting company would know the therapeutic category's medical experts, as well as those known to be skilled in adult learning principles. As long as the faculty follows the Accreditation Council for CME disclosure policy, as outlined in their Standards for Commercial Support of CME, the audience will understand the speaker's bias. It's up to the participants' own educated judgment whether the material presented was scientifically objective and balanced.
Research-based pharmaceutical manufacturers have an ethical obligation to know more about their products than anyone and to ensure that knowledge is fully conveyed to potential prescribers. Physicians rate CME as one of their most valued sources of medical information. And, repeat analyses have shown that industry funding of the CME enterprise has become essential, since funding from independent sources has rapidly decreased. Threatening ethical continued CME provider/industry collaboration, based upon the egregious actions of a few, would not be in the best interests of improved patient care.
Frederic S. Wilson
Procter & Gamble Pharmaceuticals
Health Care Research Center
Dear Editor: My first time ever writing to an editor, but you raised an issue that's near and dear to my heart. We are just a community hospital that scheduled once a week one-hour CME lectures. The vast majority of our pharmaceutical reps were honest and ethical, but a few were unbelievably, intentionally inept and thought I wasn't smart enough to catch on.
For one program, the rep gave me three possible speaker curricula vitae as requested. Two had spoken here before and were on our “don't come back” list. The third was the head of the medical school at Columbia University (remember, we're just little ol' [medical center, name withheld upon request]). So, we picked the Columbia doc, who just happened to never be available.
When I talked to the third-party communications company they were using, I found out that the rep had already scheduled and confirmed one of the speakers we had refused. I was told, “We put him down as a marketing talk then if you want him, we just change the paperwork to CME.” Nope, not on my watch, you don't!!
[We] had another company that gave me a speakers list, at my request, with about 30 speakers on it. We picked our top three and were told, sorry none of them can make it that date, but Dr. XX is available. We offered to change the date, none of the three could make that date either, but Dr. XX could. We picked three different speakers and low and behold, none of them … I played the game a little longer and it appeared that out of 30 speakers, ONLY Dr. XX would ever be able to speak to our doctors. Nope, not on my watch!!
We have a policy on consequences for a rep or company that violates the guidelines — they can be banned from participation in our CME activities — and we've used it. I could tell you more tales, but…Congratulations of your bravery in bringing this out in the open.
Name withheld upon request