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Is it possible to take the bias out of physician education?

The press has been hammering the pharmaceutical industry for trying to sway medical professionals by injecting some bias into physician education, and it's easy to see why. Physician education is based on studies that largely are underwritten by the pharmaceutical industry. Their educational activities are also largely underwritten by the pharmaceutical industry. The faculty who present the information usually have some sort of financial tie to the pharmaceutical industry, whether they receive research grants, serve as investigators in clinical trials, or participate on a pharma company's speakers bureau. Given how inextricably entwined pharma is in the whole educational process, is it possible to take the potential for bias out of continuing medical education? Or are we doomed to having our docs learn only what pharma wants them to know?

The Accreditation Council for Continuing Medical Education thinks it's possible to separate the influence from the dollars. That's why it issued its revised Standards for Commercial Support, which goes into effect May 1. When it was first announced last fall, CME providers went a little nuts--it sounded like, despite their best efforts to keep education free of pharma promotion, life as they knew it was over--the best speakers on a particular topic would be banned because they had some financial tie to pharma, regardless of safeguards they put into place. While many of those concerns are being allayed, one has to wonder if all this hoop-jumping is really necessary.

After all, docs are generally speaking pretty smart people. They've had more education than most of the rest of us, and like the public at large, they have pretty good BS detectors. Then again, studies have shown that even though most docs adamantly claim they are not swayed by free samples and other gifts, and that they can sniff a promotional pitch from a mile upwind of it, their prescribing habits do change as a result of pharma marketing (JAMA 2000, 283: 373-380). Then again, I think about my previous life editing an environmental chemistry magazine: The best research often came directly from the manufacturers, and their representatives keynoted most major meetings. No one yipped at that, even though the results they reported had a pretty direct effect on health as well.

Is pharma capable of leaving marketing outside the door without CME providers, and sometimes the feds, turning themselves inside out to police them? Obviously not (witness the TAP pharmaceutical case, among others). And that's a crying shame. But what makes pharma's involvement in education so different than the practices used by virtually every other industry that it gets constant scrutiny? And if we're all really so worried, why not just take pharma out of the equation altogether? Oh yeah, because no one else has the bucks to do the research and support the education. Take pharma dollars out, and the state of the art probably would stagnate. Maybe the new Standards will help, who knows.

A larger question, and one the Standards doesn't address, is how the types of programs offered also is swayed by pharma--if the topic isn't in their product category, they won't provide the unconditional educational grant, and that activity probably won't see the light of day, whether or not there's a demonstrated need for it. That, my friends, scares me a little. And I hear it's happening more and more these days as pharma tightens its purse strings and those slush funds that used to support things like improving interpersonal communications with patients and other "soft" topics disappear. Often, these topics have a greater impact on patient care than what's available in the latest generation of arthritus drugs. OK, that actually scares me a lot, but I don't see anything that can be done about it.

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