Doctors loath to pay for unbiased education: survey

NEW YORK (Reuters Health) - While doctors believe industry funding may bias their continuing medical education, they are unwilling to pay for impartial information, a new survey finds.

Continuing medical education, or CME, is a requirement for most U.S. physicians who want to keep their license and board certifications. It comes in a variety of forms, including online videos, journal articles and conferences.

Drugmakers and medical device companies sponsor up to 60 percent of the billion-dollar CME industry, stoking widespread worries that financial interests might be warping the way doctors treat their patients.

"It's definitely a concern," said Dr. Jeffrey Tabas, an emergency physician at the University of California, San Francisco, who also helps oversee the university's CME. "This is what we are doing to maintain our lifetime learning and improve our practice."

While some institutions have already taken steps to remove themselves from commercial influences, both UCSF and many others remain dependent on industry money.

Little is known about what individual physicians think about this relationship, so Tabas and his team decided to survey attendees at five CME courses delivered by the International AIDS Society-USA, which also receives industry funding.

They found 88 percent of 770 doctors who answered their questionnaire believed commercial support could bias CME presentations.

Less than half thought paying higher registration fees for CME activities would make sense, however, and only 15 percent would like to see industry funding completely removed.

According Tabas' report, published in the Archives of Internal Medicine, physicians spend an estimated $1,400 a year on CME. That would climb to $3,500 without support from pharmaceutical companies and device makers.

Although it's not clear from the survey, Tabas said most physicians probably believe the extent of industry bias is fairly limited.

"Because they feel in general there is not a lot of bias, they are not willing to pay to reduce it," he told Reuters Health.

Another possibility, he said, is that they think they themselves are immune to such bias, while their colleagues are not.

"We need new models of funding CME that minimize conflicts," Tabas said. "The best approach at this point is to create barriers between the money and the delivery."

Such barriers could include making sure industry money isn't earmarked for specific purposes, such as lectures about a particular drug. But Tabas acknowledged that might make companies more reluctant to pick up the considerable tab for

CME.

He said he was especially worried about support to individual faculty members, who may receive CME credits for joining a company's speakers' bureau. This practice was eliminated last year at UCSF.

Other institutions have taken more radical steps and now don't accept any industry funding for their CME. But an editorial on the findings say eliminating commercial sponsorship across the board is impossible.

"Most do not want to see it eliminated, presumably because of the resulting increased costs for registration," Dr. Todd Dorman of Johns Hopkins University in Baltimore and Dr. Ivan Silver of the University of Toronto write.

"For large groups, reducing costs and maintaining separation between commercial CME funders and providers seem essential," they add.

SOURCE: bit.ly/l1mE4h Archives of Internal Medicine, May 9, 2011.