CME has become tainted. Pharmaceutical and device companies “sponsor” CME talks at many hospitals. While some of these talks are excellent and independent of the sponsor, many are not. How can we distinguish the talks?

This trend extends beyond CME. Many journals publish “supplements” which are little more than symposia sponsored by some company.

Afterall, money rules. Money influences every business in the world. Medicine is not exempt.

The CME accreditation group would like to change how companies influence CME – Group seeks limits on drug-financed doctors

Doctors who receive drug company funding would be limited in what they could teach other physicians under new rules being proposed by accreditors.

The Chicago-based Accreditation Council for Continuing Medical Education, which gives its stamp of approval for such classes, was to announce sweeping changes Tuesday to limit the influence of doctors with financial connections to the pharmaceutical industry.

The nation’s 750,000 physicians stay up to date on medical advances through mandatory participation in thousands of continuing education activities per year.

In the past, a doctor teaching such a course would disclose his or her financial relationship with any drug company, say as a paid member of the company’s speakers’ bureau or a grant recipient. Once that was out in the open, the physician might then talk glowingly about anecdotal experience with that company’s drug.

Now, a third party with no ties to the drug company would have to tell the doctor what kind of recommendations he or she could make. Anecdotal observations would be replaced by results of systematic clinical trials. Any review of journal literature would have to include negative, as well as positive, studies.

“So this whole thing about just saying ‘I’ve got a conflict of interest. And I’ve got a relationship. And I’ve got a personal opinion. And I’m probably biased. But, I’m going to tell you anyways,’ that’s not allowed,” said Murray Kopelow, chief executive of the accreditation council.

Doctors who balk at the new rules will be barred from presenting or teaching at continuing medical education conferences.

This rule appears solid on surface review. The problem will be in finding experts without conflict of interest. In many fields, virtually all the experts receive some pharmaceutical support (often for drug trials).

I suspect that we will see a new “specialty” arise in CME. Those who have no financial ties will become the truth arbiters. And again on surface review this seems logical.

I worry that these new experts will have another axe to grind. None of us is without bias. Those who accept no pharmaceutical moneys (and I am included here) may have an anti-pharmaceutical company bias. They may tend towards therapeutic nihilism (at until the evidence is overwhelming).

Lest you think I exaggerate, consider the current debate over the AHA guidelines on treating cholesterol. The anti-pharmaceutical lobby is obsessed with the financial ties of the panel. The data appear sound to my review. I would rather err on the side of aggressive statin use until someone produces data that I am not helping my patients. The anti lobby would err on the side of withholding the drug until they are overwhelmed by new data – and probably only data that they endorse.

One more example of the problem that I fear. The ALLHAT study appears to prove that diuretics are better than ACE inhibitors as first line antihypertensives. However, the study design had clear biases against ACE inhibitors (as I have discussed many times). Further analyses and studies have confirmed that ACE inhibitors should remain first line in selected patients (especially diabetes mellitus and known heart disease).

I worry that this rule may be an over reaction to a real problem. Two wrongs do not produce a right. We need to remove blatant pharmaceutical influence from our education, but we must be careful about what happens then.

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