Reducing industry support of CME has unspoken consequences

I have worked in continuing medical education for 12 years and the argument over industry support of CME has grown tired and wearisome. Truth be told, I’m sick of it. I have always been a staunch defender of industry support of CME – and still am, for the most part – but listening to the same old arguments on both sides of the issue has become akin to the Elmo CD my 5-year-old daughter listens to every night at bedtime: so much background noise.

So, when the CME community made a kerfuffle over the recent perspective piece in the New England Journal of Medicine (Industry Support of CME — Are We at the Tipping Point?), it took me awhile to work up the motivation to click on the link and read it. As expected, the authors clearly favor restrictions to the funding of CME by industry, though they do not approach the issue with the zealotry of others I have read. However, one sentence in particular struck a chord with me. At the very end of the sixth paragraph, the authors state,

… in addition, removing the financial conflicts of interest of CME providers will probably yield a more balanced mix of content, since the existing system provides incentives for developing symposia focused on drug therapy so as to attract industry sponsors.

Probably. Will “probably” yield a more balanced mix of content. This is my problem with the anti-industry support argument – the reliance on vernacular like “probably” and “might” and “possibly” and “perceived.” If we remove speakers with conflicts of interest, content will “probably” be better balanced. If there are more restrictions on industry support, there will “probably” be beneficial effects on CME. I don’t know about you, but in my work, “probably” isn’t good enough. “Probably” isn’t acceptable.

Prove to me that content will be better balanced if we remove all speakers with a financial conflict of interest. Prove to me that a decrease in industry funding will have beneficial effects for CME. Show me research. Show me data. Enough with opinions – show me something.

Why does this issue matter so much to me?

(This is the part of the narrative where I’m supposed to launch into a diatribe about how these restrictions will hurt CME because it will mean that top faculty will not be used and innovation will be suppressed due to lack of funding. I’m not going to do that.)

People are going to lose their jobs because of it. People are losing their jobs because of it (trust me, I know). If there is less money to fund CME, there is less money to pay the people who develop it. These people are my colleagues and friends. They are dedicated professionals who have given their careers to the education of physicians. They are the human element no one thinks of whenever the issue of reducing or eliminating industry support of CME comes up. They deserve to have their fate decided by evidence stronger than “probably.”

It is easy to sit in an ivory tower and opine over the probable outcomes of reducing commercial support in CME. Just remember, these opinions, and the decisions that they affect, are not done in a vacuum. They have dramatic, real life consequences beyond those normally discussed in medical journals and editorials in the New York Times. There will be layoffs because of them. Companies will shut down because of them. Departments will close because of them. People will go on unemployment because of them. Not maybe. Not probably. They will. They are.

But, I’m a reasonable person. If you can show me evidence that the incorporation of these restriction in CME will improve physician practice and patient care, how can I argue against that? If more people are healthier and more lives are saved because of less industry dollars rolling around in CME, then maybe the loss of jobs and affect on personal lives in the CME community will be worth it. Right now, though, I’m not seeing that evidence.

You can tell me that reducing industry support will “probably” be beneficial to CME. I can tell you it “definitely” means a reduction in the CME workforce. If this is the path we’re going to go down, you better be right.

Derek Warnick is a CME Director who blogs at Confessions of a Medical Educator.

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