Physicians See Very Little Bias in Online CME, Says Survey

Checks, Balances Seem to Be Working Well, Says New COCPD Chair

By Barbara Bein
10/30/2009

A recent survey of physicians who participated in both commercially and noncommercially supported online CME activities found that participants perceived little commercial bias associated with CME activities, regardless of the funding source.

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According to "Low Rates of Reporting Commercial Bias by Physicians Following Online Continuing Medical Education Activities," in the September 2009 issue of The American Journal of Medicine, 99 percent of the physicians surveyed said online CME activities were "presented objectively and free of commercial bias."

The survey was funded by Medscape LLC, a medical education provider that offers online CME. Study authors gathered data from physicians who participated in CME activities on the company's Web site and who then completed CME activity evaluation surveys.

Of the 1,064,642 completed surveys, less than 1 percent indicated that the physician respondents detected bias, either overall or when broken down by commercially or noncommercially supported CME activities. In addition, physicians in primary care specialties reported slightly less bias than the overall rate for physicians in the nearly 30 specialties surveyed.

Study Suggests Most Doctors Deem Many Physician-Industry Collaborations Appropriate

In a study in the October 2009 issue of The American Journal of Medicine, physicians representing 35 academic departments -- including internal/general/family medicine -- at nine hospitals within the Mount Sinai School of Medicine consortium in New York City and northern New Jersey were asked to rate the appropriateness of 12 collaborations between physicians and the pharmaceutical or medical device industry.

Respondents assessed collaborations such as developing or designing a drug or device or developing or designing a clinical trial to test the safety or efficacy of a drug or device. More than 90 percent of respondents then rated such interactions as "appropriate" or "very appropriate." At the lowest end of the scale, 60 percent said that it was appropriate for a physician to prepare a manuscript reporting on the results of a clinical trial to test a drug or device, even when the physician was not involved in the trial design.

Physicians also weighed in on the appropriateness of receiving payment for the same collaborations. With only two exceptions (recruiting patients for a clinical trial in which the recruiting physician was not involved in the study design and preparing a manuscript on a clinical trial in which the recruiting physician was not involved in the study design), at least 50 percent of respondents said the collaborations were appropriate.

For both metrics, little variance was seen among responses from primary care physicians and those for the overall physician group.

"These data provide much-needed information to address concerns about commercial bias in CME, and are consistent with available peer-reviewed publications on physicians' perception of bias in commercially supported CME that indicate that most physicians do not believe that commercially supported CME is biased or creates bias in their prescribing behaviors," said the study's authors.

The findings come as no surprise to Daniel Spogen, M.D., of Reno, Nev., the new chair of the AAFP Commission on Continuing Professional Development, or COCPD. The Academy and other CME accrediting organizations have a number of checks and balances in place to ensure that CME activities are free of commercial bias, he told AAFP News Now, and the measures have worked well.

"The AAFP is committed to assuring that AAFP CME is objective and relevant and that it is not influenced inappropriately by external support or other factors that could introduce bias in a manner that could jeopardize the translation of science into research, education and practice," said Spogen. "Our commitment is to assure that AAFP CME is offered in a manner that supports professional competence, practice performance and patient outcomes."

Spogen credits measures such as financial disclosure forms for keeping commercial bias out of CME activities, including activities sponsored by the AAFP.

"Although there is increased concern with medicine's reliance on industry-supported CME, the AAFP believes that clear guidelines and effectively designed systems allow for the relationships between industry and CME providers to be managed in a way that demonstrates independence and results in quality, certified CME that is free from potential influence and bias," he said.

Spogen also said that as the new COCPD chair, he will focus on trying to remove even the perception of commercial bias in AAFP CME by ensuring, for example, that pens or other promotional items with pharmaceutical logos are not present at Academy-sponsored CME events.

Although Spogen acknowledged that there could be a cost to physician-learners for a "clean" educational product that is free of any perception of industry influence, he added that the AAFP's intention is to offset or minimize such costs by leveraging other types of funding, such as grants from governmental and other nonmedically related industry sources.

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