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Marcia Angell’s "Big Pharma, Bad Medicine" reprises several well-worn arguments that have marked her writings and lectures over the past decade. In at least one area of criticism—continuing medical education (CME) for physicians—Dr. Angell’s critique is out of date, contains inferences without evidence, and is misleading.
The CME programs that Dr. Angell describes are in fact modeled on major medical conferences put on by the largest independent medical organizations, such as the American Heart Association and American Society for Clinical Oncology. More than 200,000 physicians have participated in educational programs run by our company, Pri-Med, over the past two years. The CME materials prepared for these courses are developed by academic experts using well-documented accreditation standards that require independence from industry, as well as transparency and disclosure. Physicians and other health-care professionals come to Pri-Med events because we offer high-quality, accessible, interactive, and convenient education, and the chance to interact with and learn from both peers and renowned faculty.
Physicians and other health-care providers might encounter a pharmaceutical industry representative at these Pri-Med events, but only in a separate and clearly marked exhibit hall, just like at the major scientific meetings. Industry engages with physicians in these settings in a manner regulated by the federal government, the state governments, and industry codes. Some physicians choose to engage with industry; some don’t. The important point is that the decision is up to them, as is the decision about how to apply the information they receive in their practice.
Physicians increasingly are challenged to stay current in their practice, and CME is one way for them to obtain clinically relevant information. Advances in education design and adult-education principles provide physicians with more choices than ever about how to meet their requirements for CME. Today’s choices include online courses and events produced by professional societies or by local medical schools, as well as the Pri-Med conferences. All of these choices, regardless of the accredited-provider category, must meet the same rigorous accreditation and compliance criteria in order to be presented as certified CME.
Despite Dr. Angell’s assertions, there is no evidence that industry support of accredited, certified CME results in commercial bias in the educational experience. In fact, a growing body of evidence from peer-reviewed publications suggests just the opposite. For example:
• Over the past two years, several peer-reviewed prospective and retrospective studies from a variety of accredited providers have shown consistently that the reported commercial bias was comparably low, whether CME was commercially supported or not. The consistent conclusions from these studies are that there is no evidence that commercial support results in reported bias.
• The federal Agency for Healthcare Research and Quality (AHRQ) reported last year that based on the research available to date, CME appears to be effective at helping physicians build and retain knowledge, attitudes, kills, and behaviors, and improves clinical outcomes. AHRQ called for more research to better quantify the impact of CME interventions on physician behaviors and patient health-care quality, which Pri-Med supports.
• In 2008-2009 Pri-Med collaborated with the American Diabetes Association to assess physician-participant behaviors before and after an industry-supported CME activity. The results of this education-outcomes study, presented at the Alliance for Continuing Medical Education (ACME) annual meeting in 2009, demonstrate improved participant adherence to ADA treatment guidelines and a positive impact on their patients’ perception of the care they provided.
Continuing medical education is a dynamic and evolving field, and perhaps no changes have been more profound than those of the past five years. We remain committed to leading the way in innovation, and to rigorously documenting the impact that our work has on improving the clinical education available to physicians, as well as other health care providers, and ultimately the quality of patient care they deliver.
Relationships between academic institutions and biotechnology companies create conflicts of interest that undermine the goals of academic medicine and harm the public.
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