The debate over CME and industry influence continues

Editor’s note: Back in June (Listening to industry: what’s the ROI of medical education?) I commented on some statements made by Bill Cooney, the President & CEO of Medpoint Communications, which is, in its own words, “a global leader in diversified communications services for leading pharmaceutical and biotechnology companies.” Cooney recently commented on my post, and this has provoked a fascinating and (highly welcome) civil debate about the role of CME and industry influence. Now Cooney has responded to my most recent comment. His response is reprinted below. The rest of the exchange is available here. I will respond to Cooney’s points late next week after the ESC meeting concludes.

September 5 Update: My response to Bill Cooney has been added at the bottom of this post.

Here is Cooney’s message of August 27:

Larry,

Your description above on how we disagree is fair enough. I believe that a wide and appropriate gulf exists currently between CME activities and promotional activities of pharma companies. You don’t. I perceive that the great majority of CME programs are truly independent, balanced, and quite beneficial to clincians. You disagree.

I’ll grant you that pharma companies tend to fund activities is disease states in which they have a commercial interest, but they also routinely fund CME activities with no commercial relevance. But it is reasonable to say that pharma funding skews the mix of all CME offered to certain disease states. It’s also true that, with an explosion of options since the advent of the web, clinicians can get CME on almost any clinical topic they seek. Eliminating commercially-supported CME won’t create better CME for under-served topics, it will just reduce choice and take away some excellent programs.

I’ll also grant you that, in a small fraction of cases today, bias can and does occur in CME programs. That will probably never go away entirely, and the critics, like you, should keep up the pressure. But anyone in the field can attest to how fundamentally different and better CME is today than a decade ago. And the audience for CME is on the look-out, so biased programs, I believe, are self-defeating.

Your point about physicians becoming financially dependent on speaker income is fair and important. There should be strict limits on annual payments, and there are at almost every pharma company, but it’s still a concern. I think this concern is reasonably constrained by conducting truly independent CME, by the preceptiveness of physician audiences, and ultimately, by the personal integrity of those invoved.

In the real world, commercially supported CME will never be perfect, but can be (and I think is) very good. It boils down to costs versus benefits: Is the US medical community better off with or without commercial support of CME? It’s clear where we both stand on that question.

But we also disagree on how to resolve the concern over bias creeping into CME. You advocate a regulatory solution, banning commercial support, so that physicians are protected from being manipulated. I endorse a free-market solution so that, as long as there is open disclosure and reasonable oversight of CME providers, physicians don’t need to be protected by a ban imposed by their peers from on high. Poll after poll has shown that an over-whelming majority of US physicians want commercially-supported CME. I say, let individual physicians make the final judgement on the merits of commercially supported CME, with their feet.

Bill

Here is my September 5 response:

Bill,

Once again I appreciate your thoughtful response. I had expected to write a lengthy response but after re-reading your comments I’m not sure it’s necessary. I don’t actually disagree with most of what you say, and where I do it’s a matter of degree and interpretation. I do find it interesting that you concede a lot of ground, agreeing that CME is skewed toward certain disease states, that in some cases bias does occur in CME programs, and that speakers can become dependent on speaking income.

So I will just address a few points: you defend the current system as “a free-market solution.” I disagree. Instead we have a market that has been entirely bought by industry. A true free market would entail physicians buying CME programs with their own money. You can bet that the free market created by such an environment would be very different from the current market.

Finally, you write that physicians overwhelmingly want commercially-supported CME. For a moment, let’s assume that you’re right (though my guess is that the scientific validity of these polls is highly questionable). However, just as we wouldn’t accept the results of a poll asking junkies if they’d like to receive free drugs, I don’t think we should accept the results of these sort of polls. The problem is that physicians have become addicted to free, industry-supported CME. It’s time for them to go cold turkey.

Best,

Larry