Funding for continuing medical education

[CMAJ Editor-in-chief responds:]

In writing this editorial,1 we aimed to ignite a public debate on an issue at the core of medical practice: industry sponsorship of continuing medical education activities. Judging from the number and diversity of views expressed in these letters and the large amount of personal correspondence I have received, we have achieved our goal.

I was heartened to hear that many of you believe that industry's influence in this regard is ubiquitous and is a cause for concern. Many of you acknowledged the need to engage in constructive dialogue with stakeholders to find a new way forward. This was best exemplified by the Canadian Medical Association, which is initiating a national dialogue with many of Canada's specialty societies and colleges. As these letters attest, Canada's institutions have made a concerted effort to improve the situation.

We still have a long way to go. I receive invitations to attend industry-sponsored academic rounds on a daily basis. I have often attended rounds where the speaker has not declared his or her conflicts of interest, have been invited to speak in symposia that were directly or indirectly sponsored by industry, and have witnessed how unrestricted educational grants can influence educational programs.

As some letters have pointed out, CMAJ is partly funded by industry advertising. We do, however, have extensive protective mechanisms in place to prevent industry influence on our editorial content. We will describe these in a forthcoming article.

Meanwhile, here are some questions that might push the debate forward: What proportion of the total funding of the continuing professional development enterprise should be funded by industry? How can we best minimize biases, perceived or real, that arise from pharmaceutical funding? How do we best promote educational activities involving various health professionals? Would we benefit from greater access to evidence-based resources integrated into our practices, free of real or perceived biases? And would a new, arm's-length institution be best suited to address these questions?

We must first acknowledge existing difficulties; otherwise a national dialogue will be fruitless.

Let the debate continue…