One of the great teachers advised his departing medical students: Lifelong learning is your responsibility. No one is better suited than you to determine your own educational needs. The opportunities for continued learning are now better than ever due to the development of the Internet. Unfortunately, there is a movement afoot to limit those options. A growing McCarthyesque purge seeks to restrict our educational choices by banning industry support of continuing medical education (CME).With the proliferation of new drugs in the 1950s and 1960s, organized medicine became increasingly concerned about the educational needs of practicing physicians. At the same time, the pharmaceutical industry realized a substantial commercial interest in marketing its products to physicians. A partnership between the profession and industry in the continuing education of doctors was a natural outgrowth. By 1975, the cost of CME was a growing concern, and it was recognized that outside sources of funding were needed to help defray this cost. Regulatory safeguards and firewalls were gradually built. These safeguards, however, are not enough for those who want a complete ban on industry support for accredited CME.

The Consequences

Whether a patient privacy law or a clinical performance measure is being proposed, there are always unintended consequences to consider. Given that CME receives more than half of its support from industry, it's easy to anticipate the effect of a ban on doctors' educational choices. Extensive experience as both a planner and a participant of CME activities has taught me that our options for continuing education would be severely limited without some degree of industry support. Nearly all high-quality educational conventions sponsored by professional societies would cease to exist. Many accredited, cost-free Internet offerings would be a thing of the past. If pharmaceutical companies were banned from spending money on accredited CME, those funds would, in all likelihood, be spent on marketing. Physicians would be bombarded by even more information from industry, but in the absence of the safeguards and quality standards of accredited CME.

The Evidence

The inevitability of unintended consequences places a burden of proof on the proponents of a ban. Is there evidence to sustain that burden of proof? No. Although the published literature is filled with opinion pieces speaking against industry support, no evidence exists that such support degrades educational content or has an adverse effect on patient outcomes. According to survey data, an overwhelming number of CME participants found commercially supported offerings to be unbiased and of comparable quality to nonsupported offerings. Furthermore, a recently published literature review showed that the Accreditation Council on Continuing Medical Education (ACCME) found no evidence that commercial support for CME results in bias or adverse effects on patient care.

The Belief System

Unable to marshal evidence to support their proposal, the proponents of the ban have appealed to a set of beliefs. One such belief is based on the caricature of a credulous physician incapable of critical appraisal of educational content. Anthony DeMaria, MD, Editor of the Journal of the American College of Cardiology, disputed this popular distortion in a recent editorial: I have a further, even more basic, reservation about the proposal to end commercial support for CME. Inherent in such an action is the idea that physicians are like sheep: easily led and without the ability to recognize biased or slanted information. I find this demeaning to the profession. In my experience, physicians are more skeptical than naïve; by nature they are not anxious to accept, but rather are waiting to be convinced. Given the competitive demands entailed in becoming a physician, we are likely intelligent enough to recognize bias when it is present.Even worse is what follows from this faulty premise: Mind-numbed doctors need an intellectually lazy solution for the appraisal of educational content -- a litmus test. If it's accredited and not industry-supported, it must be trustworthy. Doctors deserve reliable CME offerings, but no litmus test is a substitute for the critical appraisal and review of primary sources.

Conclusion

It would be a mistake to end industry support of accredited CME. A ban would restrict doctors' choices. Pharmaceutical companies would divert CME funds to purely promotional materials, diminishing the overall quality of information to which doctors are exposed. Proponents of a ban have failed to sustain the burden of proof that benefits would outweigh the unintended consequences.