As a director of one of the country’s oldest CME courses, the New York University (NYU) Seminar in Advanced Rheumatology, I review the participants’ comments about the quality of the speakers and their lectures. Physicians attending the NYU Seminar are very quick to point out what they believe is commercial bias, although some comment on what is an idiosyncratic (or even idiotic) opinion on the part of a speaker (we do try to avoid the more idiotic speakers). Speakers often have a strong opinion or even a bias, but as long as they are not paid by a pharmaceutical company, it is permissible to have them give a lecture at a CME event. Frankly, I would prefer John Vane (or his living equivalent) to Andrew Weil, although under current rules I would not be given the choice.
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There have clearly been abuses by pharma in marketing drugs, leading to increasing restrictions on their participation in medical education. In a recent editorial, The New York Times has suggested that rules governing the relationship of industry to professional societies such as the ACR, “…should have completely eliminated industry financing and found other resources or required doctors to pay the full cost of their continuing education.”1 There are no other resources to help pay for CME and, in my experience as a course director, tuition covers less than half of the cost of putting on our course. Despite their support for our course, pharmaceutical companies play no role in choosing the topics to be covered or the speakers who are invited. We invite the speakers before we have lined up any support, and I am certain this is true for the courses put on by other academic institutions and organizations such as the ACR.
Discussions of conflict of interest and the rules governing conflicts of interest in providing CME have taken on an increasingly totalitarian cast. These rules, which assume that speakers are guilty of bias until proven innocent, can prevent a pharma employee—whether a member of the National Academy of Sciences or a Nobel Laureate—from participating in the program of a CME course. To my way of thinking, the rules promulgated by the ACCME are wrong and are increasingly turning medical education into an intellectual Myanmar. So, to paraphrase President Ronald Reagan’s plea, “ACCME, tear down those walls.” Pharmaceutical agitprop is unlikely to stand when the source of the information is known.
