Orchestration of Continuing Medical Education

Based on my very direct experience, quite frankly, the CME lectures which everybody espouses as being appropriate interaction for the best, can be the most biased presentations of any you’ll ever see given—and you don’t ever trace back the funding for the CME group to the couple of companies giving the vast majority of the money to one of those speakers bureaus. So while CMEs are given a veneer of legitimacy they actually can be very dangerous to the public educational experience.—Interviewed clinical researcher (oncologist)

KOL

In many jurisdictions, physicians must take continuing medical education (CME) courses to maintain accreditation. CME is supposed to be independent of corporate interests—sponsors are not allowed to control the content of courses. For pharmaceutical companies, this is the best kind of marketing: directed at receptive audiences that need to educate themselves and provided by sources that the audiences have reasons to trust.

The independent agencies that organize most of these courses are allowed to provide organization, pay for speakers, help speakers prepare their talks, and provide entertainment for participants. In 2012, commercial support for CME (including advertising and related income) in the USA accounted for roughly 40% of income for accredited CME providers, a considerable reduction from a few years earlier (Accreditation Council for Continuing Medical Education 2012).

Accredited CME providers are subject to regulation, the most important aspect of which is that sponsors like pharmaceutical companies may not control the content of courses. In the USA, pharmaceutical companies may provide funding for CME, may provide organization, pay for KOL speakers, help them prepare their talks, and provide entertainment for participants. In some cases, even fully independent organizations may invite them to influence content: for example, one letter by a Canadian medical organization soliciting funds for a CME conference stated that “major sponsors will be given the opportunity to nominate participants to represent industry’s interest and to participate actively in the conference” (Brody 2007: 208). But in theory, the company must allow speakers complete freedom when it comes to the actual content.

Yet, for pharmaceutical companies, it is only a modest challenge to align KOLs with their own interests when it comes to CME. If the above measures of support are not enough, companies have further systems and methods of orchestrating CMEs indirectly. If sponsors have chosen their speakers well, supported the research of these speakers, and given them templates and slides for their talks, the courses will convey preferred messages.

The companies attempt to carefully manage their KOLs, their promotional talks, and their contributions to CME. At the very least, those talks tend to strongly endorse the sponsor’s products. As one medical education and communication company advertised: “Medical education is a powerful tool that can deliver your message to key audiences, and get those audiences to take action that benefits your product” (quoted in Angell 2004: 139). Both promotional and CME talks, then, are part of pharmaceutical companies’ promotional campaigns. Any education their talks provide and any health benefits that result from it have to be understood as shaped by the sponsoring companies’ interests. According to an industry education specialist, the ideal for CME is “control—leaving nothing to chance” (Bohdanowicz 2009).

 
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