Recently in CME Category

In an unprecedented move, Pfizer is immediately cutting off all CME grants given directly to medical education communications companies (MECCs), according to today's press release from the company. However, Pfizer will honor existing grant committments and will continue to provide financial support for physician-directed CME to healthcare facilities and medical societies.

The move unfairly implies that MECCs, unlike other ACCME-accredited organizations, have specifically undermined the credibility of pharma-supported CME; although Pfizer does nothing more than make the implication. Joseph Feczko, Pfizer's Chief Medical Officer, is quoted: "We understand that even the appearance of conflicts in CME is damaging and we are determined to take actions that are in the best interests of patients and physicians." It is presumed that academic centers or medical societies, unlike like MECCs, confer a desirable credibility to CME.

According to the Dow Jones Newswires, Pfizer spent approximately $80 million last year on CME, with less than half given directly to for-profit MECCs. It is unknown if other pharma companies will follow Pfizer's lead; but if MECCs are to survive the current and impending climate of ill will toward pharma-supported CME, they will need to partner up with academic CME offices or medical societies in jointly sponsored CME projects. In this event, MECCs will no longer need independent accreditation from the ACCME, which at last count accredited 155 MECCs.*

HT: WSJ Health Blog

* Not counting initial or reaccreditation ACCME fees, the loss of annual fees from these 155 accredited MECCs would amount to a yearly loss of at least $310,000 for the ACCME.

Update: On a Pfizer-related note, Derek Lowe at In the Pipeline hears rumors of autumn layoffs at Groton.

And the Congressional letters just keep on comin'.

This time the target is Murry Kopelow, MD, chief executive of the Accreditation Council for Continuing Medical Education (ACCME), the organization that bestows accreditation on MECCs, medical societies, and universities to deliver certified CME. Senator Herb Kohl (D-WI), chairman of the Senate Special Committee on Aging, sent a letter June 20 (link courtesy of Pharmalot) as part of an ongoing investigation to determine the influence that pharma has on CME. The contents of the letter indicate that Senator Kohl and the Committee have much to learn.

As the Committee continues its examination of the relationship between physicians and pharmaceutical companies, we have become concerned with reports that pharmaceutical companies are increasingly [emphases added] using continuing medical education (CME) events as a vehicle to increase the market for their products.

The opposite is true. Thanks largely to heavy fines exacted by the Office of the Inspector General (OIG) for off-label promotion,* pharma has become decreasingly involved in the development of content for industry-sponsored CME. In my MECC experience during the last several years, pharma has continued to play a decidedly hands-off role in the development of CME programs for which they provide financial support. Some companies have even gone so far as to recuse themselves entirely of reviewing the content (even for medical-legal purposes) before the program is released publicly.

According to the [ACCME] 2006 annual report, commercial support for CME activities accounted for $1.2 million, or half of the budget for CME courses in the United States.

For what it's worth, the most recent number may actually be a little higher, accounting for 60% of the US CME budget.

Of particular concern are instances where drug companies use CME courses to encourage physicians to use their products for potentially controversial medical practice. For example, it has come to the Committee's attention that one pharmaceutical company, which produces an anti-herpes drug, sponsors CME events which promote testing all pregnant women for herpes.

Senator Kohl may consider this nitpicking, but how does a CME program on pregnancy concern senior care? Couldn't the Senator or the Committee's investigators find a more relevant and objectionable CME program?

In any event, it appears that Senator Kohl is referring to GlaxoSmithKline's support of at least one Medscape-produced CME program ("Genital Herpes and Pregnancy"), which expired more than a year ago. GSK is the maker of valacyclovir (Valtrex), which is indicated for "the treatment or suppression of genital herpes [HSV] in immunocompetent individuals and for the suppression of recurrent genital herpes in HIV-infected individuals."

The Medscape program was delivered by Zane Brown, MD, Professor of OB-GYN at the University of Washington, and Serdar Ural, MD, then of U Penn, who (along with the accredited bodies of Medscape and the Medical Education Collaborative) are responsible for the program's content. Brown, in particular, urged HSV testing of all women during early pregnancy, which is based on (according to the program) his data published in the NEJM in 1997, JAMA in 2003, the American Journal of Obstetrics and Gynecology in 2004, and Obstetrics and Gynecology in 2005. Also Brown's experience with a newborn's death caused by congenital herpes (shown in the program) is probably enough for any doctor to mandate HSV testing for all pregnant women in his/her practice.

However, routine testing for herpes in pregnancy is not recommended by any scientific evidence or any national expert panel. In fact, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the United States Preventive Services Task Force all reject prenatal herpes testing due to the dearth of evidence that exists to recommend routine screening and the potential harm to many low-risk women and fetuses from the side effects of antiviral therapy.

Drs. Brown and Ural may disagree with the Committee (and again, shouldn't we be talking about conditions that affect the aging?) that "routine testing...is not recommended by any scientific evidence." And while it is true that the ACOG, the CDC, and the US Preventive Services Task Force do not recommend routine HSV testing for all pregnant women, this may be a point on which obstetricians reasonably disagree. For instance, in the Medscape program, the majority of program participants (64%) said that they do offer HSV testing to all of their pregnant patients. Dr. Brown also offers the following explanation about ACOG's recommendations to not routinely screen for HSV: "A reason that ACOG is reluctant to issue a new bulletin is because they are concerned about the medical-legal ramifications of widespread screening. On the other hand, I would just ask you to consider a woman whose baby develops a case of neonatal herpes..."

I am troubled by any attempt to persuade physicians to use a drug treatment for any reason other than the patient's condition and the drug's effectiveness in treating it.

Senator Kohl, at least as far as the Medscape program is concerned, appears to be missing its point. The program (as far as I read it) stresses the detection of subclinical HSV during pregnancy to reduce the risk of congenital HSV (which, at the risk of repeating myself, isn't relevant to the aging). Senator Kohl is also probably out of his league here and out of line when it comes to questioning the diagnostic and therapeutic recommendations of physicians (particularly academic physicians)—even if recommended treatment is off-label (which is any physician's prerogative, even duty). I certainly wouldn't want to get into a debate with Dr. Brown on this particular issue.

Therefore, it was with great interest that the Committee took note of the ACCME's credentialing standards and practices for CME courses.

In an effort to better understand the ACCME's credentialing standards and practices for CME courses, please provide us with the following documentation and information.

1.) a copy and written description of the accreditation process for CME courses;

2.) any criteria the ACCME uses, as part of the accreditation process, regarding the scientific validity of course content;

3.) any mechanisms that ACCME has in place to ensure that no undue influence by any industry is being exerted through CME courses; and

4.) any further plans the ACCME may have in place to develop such mechanisms.

Senator Kohl appears to be making a common error here, confusing accreditation with certification. Organizations are accredited by the ACCME to deliver certified CME. An accredited organization (eg, Medscape) certifies the CME programs it produces (and can do so, because it is accredited). Therefore, the ACCME does not oversee the production of individual CME programs and would not have direct oversight of an individual program's scientific validity (nor would the ACCME have the wide expertise that is necessary to oversee the scientific validity of the myriad CME programs). The duty is left largely to the faculty who participate in the content development and delivery of CME programs, as well as the employees of the accredited organization (which are often CME experts and/or health care professionals). The mechanisms that the ACCME has in place to mitigate undue industry influence are contained in the ACCME Standards for Commercial Support. The Committee can find "further plans...to develop such mechanisms" in the ACCME's recent Policy Announcements, a document I absolutely adore. 

MECCs = medical education communications companies.

* For example, see Harris G. Pfizer to pay $430 million over promoting drug to doctors. NYT. May 14, 2004.

I've deigned to think differently from Daniel Carlat. 

A fervent critic of all industry-supported CME and the host of The Carlat Psychiatry Blog, Dr. Carlat initially expressed cautious optimism last Thursday about the ACCME's newly proposed guidelines ("ACCME Gets Serious With 'New Paradigm'") to monitor industry-supported CME. However, he showed serious disdain for the very same guidelines 48 hours later ("Using ACCME's New Rules for Bias and Profit"), evidently in response to my criticism on Friday of the ACCME's overblown and confusing verbiage in its document and the organization's apparent failure to entertain the consequences of its proposed actions.

What's somewhat perplexing, other than Dr. Carlat's turnaround opinion, is his not-so-subtle castigation—and even analysis—of me. (So what do I owe you, doctor?) Of course, the absolute gorgeousness of having a blog (other than the fact that I can use words like "gorgeousness" without fear of editing) is that I can respond to Dr. Carlat's post right here on my own little cyber-acre. So here I go.

Dr. Carlat began:

In bmartin's pro-industry-CME blog Pathophilia, there is an interesting post about the newly proposed ACCME rules intended to stamp out commercial bias while still allowing commercial support.

I wouldn't characterize my blog as "pro-industry-CME"; however, I'm not against industry-supported CME, particularly given the current guidelines for its production. Nor am I in favor of stifling the flow of information, whatever its source. It's important to remember that industry-supported CME isn't consumed in a vacuum, but that it exists in the context of commercially supported CME from various industry competitors, as well as a wealth of educational information from nonindustry sources. And doctors are a pretty independent bunch. They can and do decide, individually, what to believe and how to apply information in practice on the basis of a piece of information's provenance and a whole host of other factors, like data reproducibility and clinical experience. Moreover, to my knowledge, there are absolutely no controlled studies demonstrating that participation in industry-supported CME leads to suboptimal medical care or poor patient outcomes. 

Bmartin parses out the wording of ACCME's proposal in order to try to divine the organization's actual intentions, and finds much to ridicule. 

I parsed the ACCME's wording to express my opinion that the ACCME is in love with its own bombastic voice at the expense of meaning. 

You can detect a heavy dose of financial anxiety in this post. It's an attempt to read the tea leaves in ACCME's new policy in the hopes that it will not actually mean any significant changes in the current system. But bmartin ends on a decidedly pessimistic note, predicting that the regulations will lead to less industry funding, and ultimately, to the disappearance of ACCME itself.

Well, maybe Dr. Carlat detects financial anxiety. I thought I was just pissed off at the writing style and lack of forethought of yet another bureaucratic organization.

While I wish I could agree with bmartin, unfortunately I see this as very good news for industry support. Anybody who owns a CME company and has undergone accreditation and reaccreditation (as I have) knows that there is really nothing new in this "new" guidance. Any company will be able to demonstrate compliance with each of these and yet still produce promotional and biased CME. Let's take each of these elements point by point and apply it to a recent promotional CME article produced by Medscape (see here for more details, and see Barnard Carroll's excellent investigative journalism on Medscape here and here).

I'm not sure if Dr. Carlat's implying that I don't know what I'm talking about; however, for what it's worth, I have experienced an ACCME reaccreditation process (which, BTW, generated a lot of printed paper). But more to the point, the ACCME's newly proposed guidelines are different from the existing guidelines (other than the general guideline that content should be free of commercial bias). For instance, there is currently no mandate that educational needs must be identified by an organization that does not receive commercial support—which eliminates most (if not all) MECCs, professional organizations, and university-based CME offices. My main beef with the ACCME's newly proposed guidelines is that they're too vague in how they should or can be executed.

1. Needs assessment will have to be identified by a neutral organization. Not a problem! You want to keep the flow of money coming from Janssen to help it promote Invega? Many non-industry funded organizations will report that practitioners have a need to learn more about the appropriate use of antipsychotics. Bingo—you've just done your needs assessment.

Of course, those in the CME business know that a 1-sentence rationale from any organization is not a sufficient assessment of educational need. Needs assessments are typically multipage documents that include information from literature searches, clinician interviews, outcomes from prior CME programs, physician surveys, and other sources. 

2. Practice gaps will have to be identified by neutral organizations. Same non-issue as number one. Any reasonable organization will identify adequate treatment of schizophrenia as a "practice gap." For example, the AHRQ produced this document which can be cited to support the need for education about how to use atypical antipsychotics. Medscape will argue that focusing an article on treating a schizophrenic patient with liver disease (which just happens to be the specialty of Invega, its sponsor's medication) fills an identified "practice gap," and ACCME won't argue with them.

This point indicates that there are government sources to guide the treatment of conditions like schizophrenia, and that these sources can be used in an assessment of educational need. However, an educational activity that focuses on antipsychotic use and liver dysfunction could not rest (at least, in my experience) on the one generality—namely, that there is a need for education on the use of atypical antipsychotics. But my question to the ACCME would be Must the authors of these government-dispensed treatment recommendations have no ties to industry?

3. The curriculum must be specified by a bona fide organization. This is a hard one...let me see...okay, how about psychiatry's specialty board, the American Board of Psychiatry and Neurology, Inc., which publishes these "core competencies" in psychiatry. Go to the "Somatic treatment" section and you'll find the following recommended curriculum for psychiatrists:

Again, my question to the ACCME would be Is a specialty board, or more specifically, are the drafters of a board's core competencies sufficiently commercial-free? 

4. It must be verified as "free of commercial bias."

This is a redundancy, since this is already a centerpiece of ACCME Standards for Commercial Support. The organization will never have the resources to monitor the thousands of industry-supported CME activities hatched yearly.

Maybe they will; maybe they won't. In my scenario, I guess it's possible that there could be a point of equilibrium, where the dwindling number of CME providers can be sufficiently managed by a beefed-up ACCME—until the organization collapses from lack of fees.

So don't fret, bmartin—in fact, I would argue that this is a cause for great joy. ACCME is handing you the perfect mechanism for a commercial CME whitewash. Use some of that industry money to celebrate.

Okay, it's my turn for analysis...um, bilious sarcasm?

To expand its "operational elements," the Accreditation Council for Continuing Medical Education plans to increase its current fees and to introduce new fees for accredited providers of CME. The ACCME—the US organization that confers accreditation on universities, medical societies, and MECCs to provide CME—stated its intent to increase its revenue in an abstrusely worded annual Policy Announcements. Presently the ACCME's initial and reaccreditation fees are $6500, and its annual accreditation fee is $2000; according to its website, the ACCME provides accreditation for 740 organizations.

The ACCME did not specify its newly proposed fees in the announcements, but additional revenue is intended to support substantial staff increases and "an enhanced monitoring and surveillance system." And while information in this section of the policy document, "An Expansion to Operational Elements," remains vague, it is certainly the clearest in meaning among all sections of the document. Other informational parts of the announcements and proposed policies "for comment" are written in an overbearing, and often senseless, wordiness. Perhaps the ACCME knows what it means; the rest of us can only guess.

Let's begin with the introductory "Accredited CME is[sic] Education That Matters to Patient Care."*

The ACCME continues to emphasize that CME must be a strategic asset to all stakeholders who seek to improve health care in the US. Since 2006, the ACCME has maintained a focus on supporting a well-organized transition to a criterion-based system for the accreditation of CME providers that matches the gaps in physician competence, performance, and patient outcomes (ie, professional practice gaps) with practice-based learning and change.

In the first sentence, I pretty much stumble after "that" and then experience a full-body wince at the use of "stakeholders." In the phrase, "CME must be a strategic asset," "strategic asset" apparently means some important, positive thing; but it's really axiomatic that a cited asset would be important, so the adjective, in my mind, is unnecessary. And then I'd argue that "asset" should be supplanted with an adjective like "important." Then there's the phrase, "all stakeholders who seek to improve health care in the US." That's pretty much everybody, isn't it? So the first sentence can be distilled to something like, "The ACCME continues to emphasize that CME is important to everybody"—which is not a particularly useful or insightful introductory sentence. So just delete the whole thing. 

Then there's the second sentence: "Since 2006, the ACCME has maintained a focus on supporting..." For starters, how about, "Since 2006, the ACCME has focused..." or even "has supported..."? What has the ACCME "maintained a focus on supporting"? A "well-organized transition to a criterion-based system for the accreditation of CME providers." There are at least a few problems with this phrase. The ACCME supports a transition (and not a poorly organized transition, mind you) to a criterion-based system (BTW, it is really just 1 criterion?), but the ACCME doesn't indicate what the transition is from. A non-criterion-based system? Something like astrology? But even an astrological sign is a criterion, albeit a capricious one. So the distinction of a "criterion-based system" is nonsensical without further definition. 

To that point, the remainder of the ACCME's second sentence indicates that the "criterion-based system... matches the gaps in physician competence, performance, and patients outcomes...with practice-based learning and change." The ACCME now defines its "criterion-based system" for accreditation as something that matches gaps—or really, addresses deficiencies—in "physician competence, performance" (which are really the same) and "patients[sic] outcomes." And then the method by which these deficiencies are addressed is "practice-based learning and change." But all medically related learning is potentially applicable to practice, depending on whose practice you're talking about.

So the ACCME's definition of its "criterion-based system" for accreditation (which, when it comes down to it, is not really a system) is the CME provider's act of demonstrating (and I'm helping out the ACCME here) that there is information which has the potential to improve medical practice. Therefore..."Since 2006, the ACCME has supported the accreditation of [or simply "accredits"] CME providers who attempt to provide knowledge that elevates medical practice," or something to that effect. This statement, in its distillation, is also kind of self-evident and, therefore, unnecessary. 

I could go on and on, but the exercise is life sucking. Anyway you get my drift, even if you read only part of the Policy Announcements.

The most controversial aspect of the ACCME's Policy Announcements is in a "For Comment" section, which proposes that the commercial support of CME should only be allowed to continue after several considerable changes. These changes are likely to make the production of timely CME difficult and probably more trouble than it's worth for many providers. (The ultimate and ironic consequence [described below] of the ACCME's proposed conditions should be evident to anyone who has played chess.)

1. When educational needs are identified and verified by organizations that do not receive commercial support and are free of financial relationships with industry.

The ACCME cites government agencies as a example; although, it does not stipulate which government agencies engage in or would engage in the identification of CME needs, or how current CME providers would access or use this information to obtain grant support from industry. Also, what defines freedom from financial relationships?

2. If the CME addresses a professional practice gap of a particular group of learners that is corroborated by bona fide performance measurements (eg, National Quality Form[sic]) of the learners' own practice.

Another ill-considered hoop. Other than citing the National Quality Forum, a nonprofit "performance-improvement" organization, it's not clear what would qualify as valid corroboration. At its website, the NQF notes that it endorses a number of "clinician-level performance measures" and is currently asking for measures related to cancer, infectious disease, and surgical care. But how this information may be obtained or used by CME providers is not described by the ACCME or the NQF. 

3. When the CME content is from a continuing education curriculum specified by a bona fide organization, or entity (eg, AMA, AHRQ, ABMS, FSMB).

Again, how CME providers may obtain and use another organization's curriculum for content is not clear (and perhaps not yet known).

4. When the CME is verified as free of commercial bias.

And who or what determines commercial bias?

Now the big irony of the ACCME's proposed crackdown on commercially supported CME is that it conceivably leads to the organization's undoing through the following process. 

• Industry will provide less commercial support for CME (as has been the case during the last year or so).
• There will be considerably fewer organizations producing certified CME and, therefore, fewer organizations will need accreditation to provide CME.
• Fewer accredited CME providers will reduce the ACCME's fee revenue.

High five, ACCME.

CME = continuing medical education; MECCs = medical education communications companies.

*BTW ACCME, always capitalize verbs, no matter how short, in titles.

In an expected move, representatives of the primary voting blocks of the AMA House of Delegates—primary care doctors, state medical societies, and specialty medical societies—strongly objected to an AMA proposal to eliminate commercially supported CME, according to today's Medical Marketing & Media. The AMA's Council on Ethical and Judicial Affairs (CEJA) had recommended the phasing out of nearly all commercial support for CME, an issue which was debated at a committee hearing on Sunday, during the annual meeting of the AMA House of Delegates in Chicago.

John Kamp, executive director of the Coalition for Healthcare Communication, reported that the proposal "went down in flames," according to the paper. The CHC, along with the North American Association of Medical Education and Communication Companies (NAAMECC), objected to the CEJA proposal on the basis of 3 general arguments:

[T]he report ignores the dramatic difference between certified CME and other non-certified 'education' and thus overlooks the significant advances in the management and resolution of conflicts of interest mandated in the last several years by government, industry and the [ACCME].

[T]he report's conclusions are not based on current and scientifically relevant and rigorous evidence in the context of certified CME and do not respect dramatic progress in the past decade.

[T]he report lacks a plausible, detailed plan to ensure that the proposed elimination of $1 billion in certified CME funding would improve the quality of certified CME and patient care.

Given the objections voiced at the AMA meeting, the CEJA proposal is "referred back to the council, effectively tabling it for the year," wrote the paper.

Harvard physician Tom Stossel and psychiatrist Daniel Carlat recently debated the Massachusetts Senate ban on pharma gifts to physicians. Unfortunately, the 7-minute discussion (hosted by New England Cable News) was given the typical short shrift by TV-based media and did not include input from informed economic or legal perspectives.

However, in the brief time provided, Stossel did attempt to consider the unintended and uninvestigated consequences of banning low-ticket pharma gifts (eg, pens, notepads, sandwiches), such as the loss of state business and jobs. It is important to note that there is little-to-no evidence indicating that such gifts negatively affect physician behavior or health care outcomes. Stossel also indicated that the ban may limit pharma funding to state institutions for research.

On the other hand, Daniel Carlat—a proponent of banning all pharma gifts and pharma-funded CME—would have you believe that physicians are incapable of autonomous judgment and should, therefore, be subject to his non-evidence-based gut morality.

Photo: iStockPhoto.

Damn, kids. Just say "no" to free tuna hoagies.

That's the recommendation from a task force created by the Association of American Medical Colleges. The report proposes that any gifts from pharma—including food, medical instruments, or ghostwriting services*—should be banned from all US medical schools. And because a large chunk of medical-school education takes place within affiliated hospitals, the proposal would logically extend to these training sites as well.

The task force included representatives from medical academia and organizations concerned with medial education (the AMA and ACCME), but pharma input was also represented by Pfizer CEO Jeff Kindler, Amgen CEO Kevin Sharer, and former Lilly CEO Sidney Taurel. The task force was chaired by P. Roy Vagelos, MD, a former Merck exec.

While seemingly happy agreements were achieved on most of the task force's recommendations, Kindler and Taurel specifically objected to the report's proposal that faculty be discouraged from participating in industry-sponsored speakers' bureaus. These programs typically involve the "training" of scores of key opinion leaders (a term often loosely applied) to give talks to their regional collegues by using industry-supplied slide decks. Robert Alpern, MD, dean at Yale, likened the practice (and the Pathophilia blog agrees with him) to "ghost talking," according to today's NYT. The practice creates a conflict of interest much more egregious than whatever comes with hoovering a free sandwich on the fly.

*Gifts thoroughly enjoyed by preceding generations of medical trainees and/or their faculty.

Photo: iStockphoto.

Moving through this morning's pharma blogosphere is an AP story describing the responses of some drug or medical-device companies to Senator Chuck Grassley's request that they disclose their CME funding to outside groups. The current industry model is that of Eli Lilly, which provides a highly itemized (and therefore, very difficult-to-synthesize) online grants registry report for each financial quarter of 2007.

Among the companies' soup-to-nuts replies to Grassley:

• Medtronic will post payments for professional meetings and patient groups on May 1 (no mention of funds to medical communications companies);
• AstraZeneca will do the same on August 1;
• Merck is "currently in the process of developing an action plan";
• Amgen and Abbott have formed "working groups"; and
• nose-thumbing Schering-Plough reports that it has no plans "at the moment" to publish the requested information.

Today's WSJ Health Blog notes that Grassley's also sponsoring the Physician Payments Sunshine* Act of 2007, which will require quarterly reports from drug or medical-device companies to the DHHS regarding payments made to individual physicians or their employers.

CME = continuing medical education.

*As in, blow sunshine up my...?

From Pharmalot by way of The Carlat Psychiatry Blog: Both highlight a relatively recent editorial in Medical Meetings that was written by Donna Beales, librarian and CME coordinator at Lowell General Hospital in Lowell, MA. In the editorial, Beales maligns the current state of industry-funded CME and outlines a provocative "5 Steps to Building Real Firewalls" to separate CME from commercial interests.

My own very blunt view of Beales's editorial is that it comes from a place of ignorance, and I specify some of my objections to her proposals in the comments section of the relevant Pharmalot post.

Today, the Carlat Psychiatry Blog points to the recently published results of the 2007 annual CME survey of physicians conducted by MeetingsNet.com, and in more or less predictable fashion, Dr. Carlat leads by stressing the overwhelming perceived bias in CME among survey respondents (>80%). He concludes today’s brief post, “[L]et's hope that the ACCME and AMA take note, both of which still strongly support industry-funded CME.” However, a closer look at the survey results may be more heartening than distressing to anyone who chooses to defend industry-supported CME. My take on the survey results from the MeetingsNet publication follows, with a somewhat more nuanced interpretation of the findings than Dr. Carlat may otherwise provide on the subject.

 

With respect to observed commercial bias in certified CME activities (below), while it is true that 82% responded that they observed some degree of commercial bias in certified CME activities—meaning something more than “never”—more than half (56%) of respondents indicated that they rarely or never observed commercial bias. I found the general lack of frequently observed bias in CME remarkable, especially given the general groundswell of anti-pharma sentiment that has developed during the last several years. The breakdown of results by sex and age group was not particularly revealing, and statistically significant differences for these data (and others) were not reported (if ever assessed).

 

Observed Commercial Bias in Certified CME Activities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Among those who detected bias, disclosures regarding funding by industry or faculty relationships were, not surprisingly, cited as frequently or occasionally contributing to CME bias (below); however, I’m not sure what other factors would contribute to perceived bias in industry-funded CME activities. Consequently, I’m also surprised by the “rare” and “never” responses.

 

Source of Bias in Certified CME Activities

 

 

 

 

 

 

 

 

 

 

 

Yet, despite those physicians who indicated the presence of CME bias, more than 90% of all respondents indicated that CME activities were either somewhat or extremely effective, and no one indicated that these activities were “not at all” effective. Other curious findings from the survey include a strong physician preference (41%) for the meeting format—perhaps not surprising given the fact that MeetingsNet is in the business of promoting the meetings industry. A popular choice among physicians was “local meetings”; however, it is not specified if this choice refers to something like an institution’s weekly grand rounds session or an off-site industry-funded dinner meeting or both. Another not-so-surprising finding from the survey is the physician preference for the lecture format with question-and-answer sessions (a format that, of course, fits hand in glove with on-site meetings).

 

Among those surveyed physicians who received CME credit through online programs (only 11%), less than half provided information regarding the type of online CME in which they participated. However, among those respondents (the absolute number of which is not provided), 64% (or really 3% of all survey respondents) indicated a preference for Internet point-of-care (online self-directed) learning. The intention to use POC learning by respondents is also featured in the MeetingsNet report; 46% of physicians (I’m not sure if this is 46% of all respondents or only those 11% who participate in online CME) indicated that they plan to use the method during the next year. In any event, the manner in which the interest in POC learning is presented by MeetingsNet appears to bolster the current and perhaps future interest in POC learning among physicians. Consequently, I wonder if there’s not a reason for the seemingly pumped-up manner in which these data are presented by MeetingsNet. (In other words, is MeetingsNet also in the business of promoting Internet POC programs?)

 

Further survey data (including all-important absolute numbers) are likely to be obtained by shelling out several hundred dollars for the full report from MeetingsNet (which I will not be purchasing). So if there is additional, relevant information from the survey to consider, please provide them.