The March 18th NEJM published a letter to the authors written by Lois Colburn, the present President of SACME and myself, Todd Dorman. The letter was written in response to a previously published article by two attorneys from OIG, Morris and Taitsman entitled, “The agenda for continuing medical education-limiting industry’s influence.”
This original article was written itself from biased and outdated materials and from a position of bias. Allow me to explain.
First, the overwhelming majority of references and referenced materials are all from prior to the present CME accreditation systems and its modern day regulations. These newer and updated regulations took into account this older information and the earlier concerns about industry influence in CME and thus exist to mitigate those concerns. By utilizing outdated material and in some cases, material from other countries, the others have painted a picture of concern for CME that is really circa 5 years ago and not today and thus the solutions offered are for a system that doesn’t presently exist and are based on problems that may have been eliminated or attenuated by the newer regulations.
Second, those who write and voice their opinion in this area of conflict of interest tend to fall into three groups. Those that believe there is nothing but an obvious problem with funding and thus all funding should be removed or curtailed to the point of near non-existence. The second group is at an equal extreme position, one where they believe that the good far outweighs all potential of concern and thus not only should the present system continue to exist, but more support should be sought. The final group, and the group that Ms. Colburn and I fall into, believe in two critical principles. The first is that the issue is not the funding but the effectiveness of CME. Conflict exists everywhere and not only from funding. Thus the issue is that CME should present evidence-based education that improves the practice of medicine. Secondly, the present system has not yet been assessed and using data from a previous system to condemn the present system is foolhardy and potentially dangerous. Thus we believe that the conflict can be managed and that the first two groups are both extremists in their own right and thus biased before they enter the discussion as either no money or more money are the only possible solutions. This bias and the use of outdated material should simply be discounted in the modern day discussion of CME for what they are, misleading and inaccurate.
Lois and I are also surprised that out letter is not really answered by the authors. They chose to not address the use of outdated information and misinformation but to merely lump us with another letter that actually makes a different point. In fact, the two attorneys state that our letter is trying to state that funding poses little risk. Again, our letter, which was limited to 175 words by NEJM, is trying to state that conflict can be managed, that the past errors are being addressed and that the present system must be assessed before more changes are to be made to the system. Essentially, we are calling for a period of watchful waiting while the data can be gathered, analyzed and published. That data then should drive the next updates and improvements to the system, not biased commentary based on outdated and irrelevant material.
Lois and I hope to be able gain time face to face with the authors, not in attempt to correct their bias, but to correct the outdated and misinformation provided in their manuscript.