Playing Devil’s Advocate: Should We Have MORE Pharma Involvement In CME?

Growing up in Lancaster County, PA, I attended a moderately sized Mennonite high school. It wasn’t (isn’t) as conservative as you might think; we didn’t go to school via horse-and-buggy or refrain from clothes with buttons because they were too “worldly”. In many ways, it was a typical high school.

I do, however, remember the raging debate that flourished among the faculty, parents, and school board on the subject of teaching creationism vs evolution. Several very vocal parents of students were adamantly against the teaching of evolution in a faith-based academic institution. Creationism is what they wanted taught and what they wanted their children to learn.

It pissed me off.

Even at that age, I didn’t want to be restricted in what I learned. I didn’t want anyone to tell me what I could learn or who I could learn it from. Don’t tell me what I believe or what I don’t believe; give me the facts on both sides and I’ll make my own decision. I’m not a sheep; don’t treat me like one.

Two days ago, Dr. Murray Kopelow, CEO of the Accreditation Council for Continuing Medical Education, lead a town hall meeting for medical education companies. A large part of that meeting was dedicated to a discussion of CME and Opioid REMS. During that discussion, the question was raised as to whether CME providers would be able to have any interactions with pharma in reference to the content of REMS CME. Paraphrasing a lengthy answer from Dr. Kopelow: “No.”

This answer, of course, was expected by 99% of the audience and frankly, I’m surprised that it even came up, given the ACCME’s very public policy that industry may have no influence whatsoever on the content of certified CME.

And this is where those old feelings from Mr. Good’s Biology class start to pop-up again. Why CAN’T industry be involved in the content of CME? Why can’t my physician learners be educated in a CME-certified activity by the employee of a pharmaceutical company talking about something in that company’s line of products?

OK, yes, I understand the reasons why they can’t: of course I do – I’m a CME Director. I know the reasons too well (this is the point where I add in a little disclaimer that these are my thoughts and opinions and do not represent my employer, blah, blah, blah. Not that that’s going to change your mind about it, but there it is). But hear me out. I believe it’s possible to have a balanced CME activity with biased individual sessions. Why not? If I was the learner, I would want this. This is how I like to learn.

Not buying it? How about something like this:

Scientist from Pharma A presents research on his product.
Scientist from Pharma B presents research on his product.
Doctor Z presents his opinions/experience using both.

How is that bad? Would that not be educational? Yes, the first two sessions are going to be biased, but everyone knows that and expects that. These are the people most intimately familiar with that product; I want to hear what they have to say. I want to hear what all sides have to say and then make my own decisions. Inform me of the relationship that the speakers have with industry (which are pretty obvious, they’re employees of the company for Pete’s sake. But isn’t that even better? No “hidden” bias here: it’s right out in the open for all to see)  and will factor that bias into my decision making proces.

Here is the biggest hole I see in my argument: I give the learners too much credit. In my mind I’m thinking, “We teach doctors. They’re smart. They’re able to make reasoned decisions based on the best available evidence. Why are we so preoccupied with ‘protecting’ them from whom, and what, they learn?”

But maybe I’m wrong. Maybe this whole argument is silly. My dad always taught me that there are two sides to every story and I find that to be true oh so often. When told that I am not allowed to do something, my first instinct is to always ask “Why?”

So, this is me asking “Why?”

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5 responses to “Playing Devil’s Advocate: Should We Have MORE Pharma Involvement In CME?

  1. Question: Is Dr. Z completely devoid of his own “biases”–is he monetarily related to either product or product’s company beyond clinical use? Was he paid to use either/both products or other products from the companies clinically? How do you keep the doc’s bias about which he liked better out of the commentary, and stick strictly to experience and outcomes without drawing a conclusion about A being better than B?

    • Good questions, Lynn! As the CME provider you/we are responsible for assuring that a certified CME program is balanced. In the scenario you are referencing, I would want to make sure that my “Dr. Z” was coming from an unbiased position. I would look for someone devoid of financial relationships with either company. If I can find someone like that, I would let him draw conclusions about preference. Perhaps for sake of balance it would be preferable to have two Dr. Z’s, each with a different viewpoint on preference.

  2. This makes me wonder if certified CME is actually the best place to learn about drugs, given all the restrictions (which aren’t likely to do anything but intensify, IMHO).

    I went to a meeting (not CME) last year that included a “technology shootout” where reps from competing tech companies got 10 minutes apiece to tout the benefits of their products. No end users saying which they liked better and why. The audience peppered them with questions, asked them to compare the features of their products to each others’, etc. Everyone I spoke with about it said it was the best format they’d ever had for learning about a particular technology. As you say, of course there’s bias, but with the other companies right there to keep each other in line, it seemed pretty fair and balanced, actually.

    It would never qualify for certified CME, but wouldn’t that be an interesting way for docs to learn about new drugs?

    • Sue- Yes, I agree! Like I said, I think you can have a fair and balanced activity that includes portions that are biased. But I have heard more than once that it is not the activity as a whole that needs to balanced, but each individual section/faculty. That effectively rules out the formats you and I are suggesting from certified CME, which I think is kind of a shame.

  3. Sue, I think that’s great and wish it could be CME. In doing some research about the pharmaceutical industry’s influence on prescribing I read one report that observed that pharma reps were likely to be most acurate in their negative statements about competing products and least likely to be totally acurate in positive statements about their own products. It seems to me that a panel debate format would produce a very balanced picture!

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