A recent New England Journal of Medicine report on continuing medical education (CME) helpfully updates readers on changes to accreditation standards, but unfortunately assumes that commercial support from drug companies is and will continue to be biased if not subject to additional, draconian measures. 

The Coalition believes that commercial support provides tremendous value to patient care in America, and suggests that a dialogue on this important topic should start with a balanced explication of the relevant facts, not on unfounded and unproven assumptions.  

For example, in his February 10, 2005 article in the Journal, Robert Steinbrook, MD, cites Marsha Angel's recent muck-raking book to support the proposition that there is a "long-standing concern that it [commercially-supported CME] often involves marketing as well as education."  Later, Dr. Steinbrook suggests that one "solution" would be for the ACCME to stop accrediting commercial medical education companies, "because many of these accredited providers of CME receive much of their funding from drug companies.” 

Clearly, support for CME comes from drug and device companies. However, less than half of that funding goes to commercial providers. More than half goes to accredited medical schools, medical organizations and hospitals. Moreover, the latter three have their own financial interests and possible sources of bias. But, it is unwise to assume bias from any source unless we examine it carefully, systematically, and scientifically. While Dr. Steinbrook and other critics of commercial support have offered no evidence of bias or other harm, if the area is to be studied any legitimate review of the issue should cover all of the potential sources of bias, not just those involving commercial providers.

Most important, Dr. Steinbrook’s article ignores evidence of the significant value of this CME while omitting some very important additional facts:

1. The touchstone for accredited CME is that accredited providers must insure that the content of that CME is directly related to and relevant to the delivery of good medical care and, at the same time, that it is independent of any source of influence from the commercial supporter. 
   
   The benchmark of “independence” is the bedrock of all decisions of the ACCME accrediting system, which have been in place for years, and which only recently have been fine-tuned with the new 2004 Standards for Commercial Sponsorship (SCS).
   
   
2. The FDA -- the nation’s premier watchdog of commercial ethical behavior -- explicitly has recognized the legitimacy and importance of drug company sponsorship of CME, and continues to advise use of its standards document, first published in 1997: "Guidance on Industry-Supported Scientific and Educational Activities.”
   
   
3. The American Medical Association, PhRMA, the research-oriented pharmaceutical trade association, and AdvaMed, the medical device manufacturers association, each have excellent guidance documents for their members that set ethical and professional standards well beyond those applicable in other industries.
   
   
4. In addition to these ethical codes, the area is covered by a significant set of laws relating to fraud and illegal kickbacks that are enforced through the Office of the Inspector General (OIG) of the US Department of Health and Human Services.  These impose serious limits on the commercial sector, again, well beyond those applied to other industries.