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Dr Marlow highlights the many safeguards the College of Family Physicians of Canada has developed to root out bias in the programs they accredit. He and the College have reason to be proud of their work. They have instituted an impressive set of standards consistent with our short-term recommendations, including close scrutiny of continuing medical education (CME) providers applying for accreditation and ongoing review of new programs.
We disagree, however, with Dr Marlow’s contention that these safeguards guarantee that programs are “unquestionably balanced, free of bias, and not being used by pharmaceutical companies to market their products.” There are many subtle yet potent forms of bias and marketing that can escape even the most stringent regulations and vigilant reviewers. For example, a CME provider can choose speakers who tend to have more favourable views of a company’s product or tend to see a more expansive role for a class of drugs in which a company has major market share. Unless a speaker’s opinions fall well outside the mainstream, it can be very difficult to assess whether conscious or unconscious industry influence led to such a speaker being chosen over equally qualified but more sceptical candidates.
The issue is not one of “bad” doctors or CME providers blatantly trying to curry favour with industry sponsors. Rather, the pervasive reach of industry in education, research, and practice yields a subtle yet cumulatively powerful influence on how doctors learn and think about drugs and devices. Industry employs the brightest minds in marketing. It spends many billions of dollars each year—including funding CME—to convince doctors to use its products. In this light, it is unwise to believe that even the best-intentioned regulations and reviewers can fully eliminate commercial influence and bias in CME. It is for this reason that we recommend more sweeping long-term changes in CME funding.