Chief among these conflicts is the financial incentive for CME organizers to create educational programs that present companies’ products favourably. These conflicts affect medical education and communications companies (MECCs), many of which are for-profit and are funded almost exclusively by drug and device manufacturers. Such MECCs host accredited educational programs and many also service a variety of other industry activities, including hosting company-sponsored advisory boards and advising industry on marketing strategies and tactics.7
This presents a clear conflict, since the survival and success of both the educational and marketing arms of these companies depend on satisfying those who fund them to encourage their support of future programs.
Unfortunately, similar incentives affect academic providers of CME. Some specialty societies and university-based CME providers have assisted in potentially promotional activities, such as organizing industry-supported dinner lecture series and satellite symposia. Even university providers of CME who forego such relationships are not immune to financial conflicts. These universities often receive substantial industry support for their CME activities: in 2005, CME activities originating in US schools of medicine received 60% of their total income from industry, up from 43% 5 years earlier.2
These universities also rely heavily on industry grants for research funding and other educational initiatives.8
These connections create a web of relationships and financial dependency that can have subtle yet strong effects on the objectivity of “independent,” accredited CME. Event organizers can choose to present topics likely to favourably highlight sponsors’ products or discuss emerging clinical areas that sponsors are trying to penetrate. In addition, among a range of qualified experts on a given topic, event organizers can select speakers known to have attitudes favourable to sponsoring companies’ products. The commercial influence that results from these decisions is not necessarily acknowledged or even conscious, but might well reflect the cumulative effect of subtle influences and financial dependency that can affect even the best-intentioned CME providers.
In addition to institutional conflicts, speakers face their own conflicts of interest that arise from receiving educational or research grants from industry, from attendance at company-sponsored events, and from paid service on advisory boards and speakers bureaus.7
Although the great majority of these speakers do not intentionally teach in a biased manner, research suggests that the expectation of reciprocity, personal relationships, and fear of disrupting relationships with companies can dissuade lecturers from speaking ill of companies’ products and thus “biting the hand that feeds them.”9,10
Few published studies have evaluated directly the extent to which industry sponsorship of CME biases program content and in turn affects physicians’ behaviour.11
Corroborating data and a recent US government inquiry suggest, however, that industry uses CME for promotional purposes—with success.12
Several prominent investigations have revealed industry efforts to use educational activities to increase drug sales.7,13
In addition, drug companies track the effectiveness of marketing activities through the purchase of physician-specific prescribing data from pharmacies.14
It is unlikely that industry would contribute substantial resources to CME (approximately $1 billion [US] per year in the United States) if there were little return on that investment. Finally, some providers of CME have advertised their own educational services as having promotional benefits. For example, one MECC declared, “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.”6