If the organizers of a CME activity believe, based on what the speaker has disclosed, that the speaker has a commercial interest that may conflict with the goal of giving an honest and unbiased interpretation of the data and clinical recommendations, they may take several approaches to resolve this problem, including prior review of the material to be presented and labeling or elimination of offending portions. Alternatively, the organizers may instruct speakers to “…reference the best available evidence,” although why you would invite somebody to speak who does not do that is beyond me. Finally, the audience can be polled for their opinion on the objectivity of the presentation, an approach most commonly taken on an informal basis since most physicians seem to have fairly strong opinions on the subject. [To learn more about the ACCME’s policies on resolving personal conflicts of interest, visit www.accme.org/index.cfm/fa/faq.detail/category_id/6a4a0ce7-1e62-4fc9-a437-1e6e7eedecb2.cfm.
Needless to say, these regulations are often resented and compliance can be quite burdensome. As a director of a CME program, I have had to take a course in writing educational objectives—not something I would like to repeat and not something for which I see much value, either. Indeed, for a time, the NYU Division of Rheumatology dropped CME credits for rheumatology rounds because the regulatory burden seemed too great. I have yet to hear of or see a study documenting that all of these requirements add anything meaningful to medical education or (more to the point) influence the prescription of new or expensive drugs. Indeed, the studies, which suggest that undue commercial influence of CME leads to increased prescription of proprietary agents, never include an appropriate control (e.g., Is there a concomitant increase in diagnoses of a given condition following the presentation?).
Inherent in the proliferating regulations for CME is the view that the audience for CME talks is a mass of clinicians who uncritically receive information from speakers who themselves have uncritically received and then presented information from the pharmaceutical companies. An unscientific survey of people leaving medical lectures does not support this view. A more scientific examination of the written comments made by attendees at the NYU Course in Advanced Rheumatology also suggests a great deal of skepticism and strong basic knowledge of the subject matter on the part of people in practice in rheumatology.
Trading the Carrot for the Stick
More tellingly, Medicare must not believe that CME successfully indoctrinates physicians, either, because it now pays physicians to document adherence to standards of care.1 For example, it has been known for years that individuals who have had a myocardial infarction should be administered beta blockers and aspirin, and lecturers throughout the country stress this information to residents and attending staff at CME events. Nevertheless, compliance with therapeutic guidelines by physicians remains limited unless a variety of other measures are taken (computerized automatic ordering and the like).