The Relationship between Commercial Support and Bias in Continuing Medical Education Activities: A Review of the Literature


The ACCME commissioned and has just released this literature review:

Cervero RM, Jiang H. The Relationship between Commercial Support and Bias in Continuing Medical Education Activities: A Review of the Literature. Accreditation Council on Continuing Medical Education, June 2008.

Background and Purpose (excerpt) : As the foundations for modern approaches to medical education were being built in the early years of the 20th century, William Osler fretted about the encroachment of pharmaceutical companies. He was concerned that physicians may come to rely on the “specious and seductive pamphlets issued by pharmaceutical houses, the bastard literature which floods the mail” and the salesmen who “are ready to express the most emphatic opinions on questions about which the greatest masters of our art are doubtful” (Osler, 1906, pp. 300-301). What was once a minor distraction in the early part of the last century has turned into a full-blown issue in the past two decades as attention has focused on how commercial interests impact medical practice, research, and education (Angell, 2005; Blumenthal, 2004; Brenann et al., 2006; DeAngelis, & Fontanarosa, 2008). This has become a much more serious issue now because: “Interactions between drug companies and doctors are pervasive. Relationships begin in medical school, continue during residency training, and persist throughout physicians’ careers. The pervasiveness of these interactions results in part from a huge investment by the pharmaceutical industry in marketing” (Blumenthal, 2004, p. 1885). The concern raised in the literature is that industry support of research, education, and practice creates potential “conflicts of interests between physicians’ commitment to patient care and the desire of  pharmaceutical companies and their representatives to sell their products” (Brennan, et. al., 2006). This concern has gained a great deal of traction because of the argument’s face validity that pharmaceutical companies and device manufacturers would make such marketing investments precisely because there was a demonstrable positive impact on product sales. For example, a recent study (Steinman et al., 2006) showed how Parke-Davis’s marketing plan used many avenues, including research, publication, and educational activities, to promote the use of Gabapentin.

From the conclusion:
It is necessary at this time to initiate rigorous scientific studies to address important questions about the relationship between commercial support and bias in CME. The
research could focus on several questions:
• Does commercial support produce bias in CME activities?
• What are the mechanisms by which bias is produced?
• Are accreditation guidelines or other strategies effective in preventing bias?
• In what ways does commercial support of CME contribute to physicians’ adoption of the sponsor’s product in the context of the other influences on their clinical
decision-making?
• As a result of commercially-supported CME, does physicians’ adoption of the sponsor’s product lead to better patient care?


%d bloggers like this: