Are physician education programmes about to break free from the shackles of Big Pharma?

There's a lot of interesting chatter around at the moment about pharmaceutical industry funding of Continuing Medical Education (CME) for physicians.

Qualified doctors are expected to keep up to date with the latest research and treatments in their field by completing educational activities, which generally take the form of quizzes that participants must complete having watched a video, read an article, attended a lecture and so on. In the US, the Accreditation Council for Continuing Medical Education awards credits for CME activities that are necessary in many states for physicians to maintain their licence to practice year on year.

CME activities are generally developed and peer reviewed by leaders in their field, and are often delivered online or in print free of charge. And this is where pharmaceutical industry funding and accusations of bias come in to the issue. It stands to reason that a pharmaceutical company wouldn't bother funding a CME programme for a therapeutic area that they are not active in, and it's also not unlikely that such programmes might overplay the benefits of a drug made by the sponsor over those made by their competitors.

And so to the great CME funding debacle of 2008. Earlier this year, pharmaceutical giant Pfizer declared that it would stop funding CME programs made by medical communications companies, although, interestingly, would continue to fund those run by not-for-profit groups.

Now Stanford University in California has now pledged to stop direct industry funding of CME, although Memorial Sloan Kettering Cancer Center in New York has been doing without since January last year.

All this news has got commentators sounding the death knell for industry-sponsored CME, with the British Medical Journal declaring the end of the free lunch for doctors while others more portentously state that 2008 could herald the end of CME as we know it.

So could these events be the birth pains of a new area of untainted CME? Let's hand it to the doctors, one group who have a lot to win or lose in this argument. After all, a big feature recently published in the Journal of the American Medical Association on the long association between the pharmaceutical industry and CME programmes lays the blame for industry involvement squarely on physicians.

US physician and blogger David Toub in Pennsylvania suggests that CME might eventually become completely disentangled from the pharmaceutical industry once companies are unable to directly promote their products, although doctors may well end up having to pay for CME activities. Similarly, Dr Carlat in Massachusetts has been blogging on the issue of industry funded CME for quite some time and is firmly of the opinion that such funding "leads to many bad things, including biased education, corrupt physicians, and, ultimately, harm to our patients".

Dr RW Donnell in Arkansas, on the other hand, states that "the inquisition against industry supported CME is knee-jerk and intellectually lazy", and believes that CME programmes are inherently going to have some degree of bias thanks to the experiences and opinions of the doctors who develop them, whereas actual commercial bias is thin on the ground.

This issue has raged at conferences and online for a very long time and is due some sort of resolution, although whether 2008 is the year for closure depends on how pharmaceutical companies and CME providers react to all the heat. Better keep an eye on those news stories...