Tuesday, December 7, 2010

Is Commercially Sponsored CME Biased?

I've addressed commentary by Thomas Sullivan, CEO of Rockpointe, a medical education and communications company with strong ties to the drug industry, in previous posts:
http://brodyhooked.blogspot.com/2010/08/reply-to-my-article-on-coi-coke-aafp.html
http://brodyhooked.blogspot.com/2010/09/my-long-post-on-donald-lights-study-of.html

I gave him high marks for care and thoroughness in arguing the opposing point of view. I'm not sure I can be so generous with regard to his latest:
http://www.kevinmd.com/blog/2010/12/commercially-funded-cme-programs-bias-removed.html#more-49396

Mr. Sullivan is upset because commercial support for CME programs has been on the wane in recent years, in part because of what he believes is unwarranted suspicion about commercial bias, a charge he considers baseless. He details all the safeguards built into the CME system which, if they worked as they are supposed to, would indeed guarantee very little if any bias based on who pays the piper. (I listed reasons both in this blog and in HOOKED to doubt that the system works so well much of the time.)

Here, for brevity, I'll just make two points.

Mr. Sullivan writes, "Despite these safeguards, critics point out that because many other professionals pay for their own continuing education, doctors should begin doing the same. These critics believe that industry funded CME 'is not education, but subtle marketing,' despite overwhelming evidence from three studies this year that showed almost no bias in commercially funded CME programs..." Now, just what is this overwhelming evidence? He proceeds to cite (and provide links to) three research studies. What did the studies show? When physicians attend CME programs, they have to check off boxes on an evaluation sheet, stating whether they do or don't think that the presentation they just listened to showed inappropriate or excessive commercial bias. What all three studies showed is that the vast majority of docs, most all the time, check the NO box. To me that suggests that either the docs are lazy about what boxes they check, or else that they may be unable to detect bias when it might actually exist. To suggest that a study that consists of these data show positively that no bias exists in CME programs seems a far stretch. (There might in fact be no commercial bias in CME programs, but you'd need far better methods than in these three studies to know that.)

In a more minor point, Mr. Sullivan goes on at length listing the conflicts of interest of Dr. Martin Samuels, a Harvard neurologist who's just announced that he's starting up a no-commercial-sponsorship CME program to address the supposed problem of bias. (Some similar firms have been running non-commercially sponsored CME programs for decades and have a great track record, but as they don't come from Harvard, apparently they're chopped liver.) It's interesting that Mr. Sullivan forgot to mention that as a MECC exec he might have a few conflicts of interest of his own.

1 comment:

marilynmann said...

"as a MECC executive he might have a few conflicts of interest of his own"

Credibility not.