Physicians wary of commercially supported CME, but loath to cut it

Medical professionals are concerned about commercial bias from industry-supported continuing medical education (CME) programs, but they underestimate the costs of putting on such events and are unwilling to pay higher fees to offset or eliminate event costs.

Drug and device makers support up to 60% of accredited CME costs in the U.S., but in 2007, physicians spent an average of slightly more than $1,400 per year for CME. Commercial-free events would have cost about $3,500.

To assess clinician attitudes about commercially supported CME, researchers delivered a structured questionnaire to 1,347 participants at five live one-day educational courses designed for physicians and other clinicians (such as nurses, nurse practitioners, and physician assistants) delivered by the International AIDS Society-USA (IAS-USA) from January through June 2009. IAS-USA requires that commercially supported programs receive unrestricted educational grants from several companies with competing products.

Participants were recruited through morning podium announcements. Results appeared in the May 9 Archives of Internal Medicine.

Of 770 respondents (a 57% response rate), 378 (55%) were physicians; 242 (35%) were registered nurses, nurse practitioners, or physician assistants; and the rest had PhDs or other academic degrees.

Most (88%) believed that commercial support introduces bias, with greater amounts of support introducing greater risk of bias. Of 365 physicians who answered the question, 27 (7%) thought there was moderate or large potential bias in activities without commercial funding. As the funding increased, so did the level of suspicion: At 20% industry support, it was 156 of 341 physicians (46%); at 60% industry support, it was 273 of 343 (80%); and at 80% industry support, it was 300 of 351 (86%). Respondents also perceived greater potential bias from single-company support than from multicompany support.

Respondents also perceived significant potential bias from commercial support of the conference faculty. Most physicians (265 of 361 [73%]) perceived moderate to large bias from faculty members on commercial speakers' bureaus and from faculty receiving research support from industry (247 of 362 [68%]) compared with faculty who received no funding from pharmaceutical/medical device companies (18 of 361 [5%]).

Only 15%, however, supported elimination of commercial support from CME activities, and fewer than half (42%) of all attendees (169 of 369 physicians [46%], 125 of 307 others [41%]) were willing to pay increased registration fees to decrease or eliminate commercial support. Registration cost was reported as an important factor for physicians (286 of 372 [77%]) in choosing CME activities, and 208 of 370 (56%) agreed or strongly agreed that commercial support is essential for accredited CME and should not be eliminated.

Of the strategies listed to decrease costs, physicians most strongly supported using online instead of printed syllabi (203 of 366 [56%]), attending at a less desirable venue (184 of 365 [50%]) and cutting free food or snacks (180 of 364 [50%]). They also underestimated the actual costs of providing lunch and coffee at events. The least desirable strategies for decreasing costs were to provide fewer topics and speakers (41 of 363 [11%]) or to credit fewer CME hours (54 of 364 [15%]).