Introduction

According to the Office of Disease Prevention and Health Promotion, “Health communication is the study and use of communication strategies to inform and influence individual and community decisions that affect health. It links the fields of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health.” In contrast, medical advertising is the practice of publicizing service and products that are available for use or purchase by medical practitioners. It doesn’t make the buyer aware of alternative options; for example, advertising that one drug works better than another or even mentioning that another option exists for treatment.

Other forms of medical communication include: regulatory writing, in which a writer creates a document to conform to regulatory standards; patient education materials, in which materials are geared toward a patient’s reading or auditory comprehension; or continuing medical education (CME), which seeks to inform physicians and other professionals involved in the furthering of healthcare about treatments and innovations in the practice of medicine. As with advertising, these types of medical communication can take numerous forms; for example, a physician might be given an interactive video to watch as part of a CME activity in order to improve their comprehension and possible patient outcomes. In contrast to advertising, these types of medical communications are meant to be as unbiased as possible.

Background

CME is an established part of a physician’s career and a significant part of their ability to learn about new treatments or advancements in medical practice in order to improve patient outcomes. CME activities are offered as live events as in a workshop or seminar, or as online programs, audio, video, or other electronic media. An expert panel reviews a program’s content, and any financial relationships for faculty members must be disclosed.

In the US, the Accreditation Council on Continuing Medical Education (ACCME) regulates CME activities to see that they are free from manufacturer bias. Still, it is not clear if CME activities are really as unbiased as they are supposed to be.

Issue

Is CME communication really as unbiased as it purports to be?

Rule

If CME communication activities are really as unbiased as they should be, the following must be true:

1)      They must be free from a device, drug, or biologic manufacturer’s influence

2)      They must be run by an approved accreditation committee such as the ACCME

Analysis

About 80% of CME faculty receives financial support from a manufacturer and in 2008, more than half of all CME programs were supported by industry. Pharma spending on CME activities has decreased significantly within the past few years, but the industry still has a large stake in CME communication. In addition, relationships between physicians and manufacturers can extend back to the physician’s time in medical school. Physicians also say that CME is one of the most important ways they look for information that relates to their practice.

CME relies heavily on financial support from pharmaceutical and medical device manufacturers, to the point where experts on a CME review panel might lose control over their ability to accurately judge the program, therefore distorting education and medical practice. This could in turn lead to reduced efficacy in patient outcomes if a physician doesn’t have information about alternate treatments.

Conclusion

It is important to consider that CME activity is primarily about the physician-learner and the possible outcomes that could occur as a result of their participation. Pharmaceutical bias has the potential to limit a physician’s access to alternate forms of treatment and therefore limit patient outcomes. If pharmaceutical bias cannot be removed from CME communications, then it’s no better than advertising.

For more information on this issue, contact the Kulkarni Law Firm.