CMAJ • January 18, 2005; 172 (2). doi:10.1503/cmaj.1041329.
© 2005 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Does the C in CME stand for "Continuing" or "Commercial"?

Joel Lexchin* and Alan Cassels{dagger}

School of Health Policy and Management, York University, Toronto, Ont.;* School of Health Information Science, University of Victoria, Victoria, BC{dagger}

The commentaries on commercial sponsorship of continuing medical education (CME) by David Davis1 and Bernard Marlow2 contain good recommendations, but both are hampered by an incomplete analysis.

Davis refers positively to the Code of Marketing Practices of Rx&D (Canada's Research-Based Pharmaceutical Companies), the brand-name industry association.3 In discussing industry sponsorship of CME, the code states that "member companies will: support, where possible, the principles and practices of CHE [continuing health education] programs established by practitioner bodies." When it is possible and not possible to do so, the code doesn't say. Complaints, rather than active surveillance, are the means of monitoring compliance with the code.3 According to reports of the Marketing Practices Review Committee (which appear on the Rx&D Web site, at www.canadapharma.org/Industry_Publications/Code/), most of the complaints come not from doctors but from other companies, which suggests that the code's primary purpose is to level the playing field for companies rather than to enforce any ethical principles.

Marlow is opposed to restrictive actions that might choke off commercial support for high-quality educational offerings and restrict physicians' attendance at these meetings, but at least one recent commentary noted that "damage to the reputation of the profession" is a very serious concern if governing bodies don't provide proper oversight of CME activities.4 What is the evidence about the effects of company sponsorship on the quality of CME and prescribing behaviour? There is precious little, but the two studies that Marlow cites both show potentially negative outcomes.5,6

Both authors cite the landmark analysis by Wanzana,7 but neither seems to understand the subtitle of that article. The people who run pharmaceutical companies don't give gifts; rather, they make investments, on which they expect a return. In the case of CME, the total "gift" in the United States is in the range of US$700 million annually.8 Gifts such as direct or indirect financial assistance to attend CME are part of the culture of reciprocity so important in physician–industry relations, and such gifts can create unconscious obligations in physicians that industry knows will be repaid in one way or another.9

Let's be clear about industry money and CME. There is a great deal of difference between selling space for booths at medical meetings and direct industry sponsorship in financing CME. The former is equivalent to selling advertising in medical journals, a practice that journal editors vigorously assert does not compromise editorial standards.10 The latter is more like pharmaceutical companies underwriting journal supplements that are used for their promotional attributes.11

If drug companies' primary motivation for contributing to CME is to advance physicians' knowledge, then they should heartily embrace a system whereby they place their money into a blind trust from which independent parties organizing CME events would be able to draw.

Footnotes

Competing interests: None declared.


References

  1. Davis DA. CME and the pharmaceutical industry: two worlds, three views, four steps [editorial]. CMAJ 2004;171(2):149-50.[Free Full Text]
  2. Marlow B. The future sponsorship of CME in Canada: Industry, government, physicians or a blend? [editorial]. CMAJ 2004;171(2):150-1.[Free Full Text]
  3. Code of marketing practices. Ottawa: Canada's Research-Based Pharmaceutical Companies; revised 2004 Jan. Available: www.canadapharma.org/Industry_Publications/Code/Code_of_marketing-ENJan2004.pdf (accessed 2004 Nov 16).
  4. What's wrong with CME? [editorial]. CMAJ 2004; 170(6):917.[Free Full Text]
  5. Bowman MA. The impact of drug company funding on the content of continuing medical education. Mobius 1986;6:66-9.
  6. Bowman MA, Pearle DL. Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Contin Educ Health Prof 1988;8:13-20.[Medline]
  7. Wazana A. Physicians and the pharmaceutical industry. Is a gift ever just a gift? JAMA 2000; 283: 373-80.[Abstract/Free Full Text]
  8. Moynihan R. Drug company sponsorship of education could be replaced at a fraction of its cost. BMJ 2003;326:1163.[Free Full Text]
  9. Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252-5. [Free Full Text]
  10. Morgan PP. Pharmaceutical advertising in medical journals [editorial]. CMAJ 1984;130:1412.
  11. Bero LA, Galbraith A, Rennie D. The publication of sponsored symposiums in medical journals. N Engl J Med 1992;327:1135-40.[Abstract]




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