Several weeks ago, the Accreditation Council for Continuing Medical Education (ACCME) announced a new rule banning corporate logos from accredited educational materials for physicians. The ACCME sets standards for the continuing medical education (CME) that most practicing physicians must obtain in order to renew their licenses. Pharmaceutical companies often fund CME, and previously chose whether or not to include their corporate logo on the material.
According to ACCME’s President and CEO Murray Kopelow, their decision was made to “continue the separation of promotion from education.” Evidence-based, unbiased CME is certainly important. In 46 states, doctors are required to obtain CME credits each year, so CME is highly likely to affect physician practice and patient care. From 2007 to2012, according to ACCME’s 2012 annual report, more than a third (34 percent to 48 percent) of total CME funding came from commercial entities; 98 percent of commercial support was from pharmaceutical companies.
To mitigate bias, the ACCME requires that CME include conflict-of-interest disclosures, adverse event information, and only generic names of drugs. But our ongoing research indicates that pharma-funded CME is still laden with marketing messages and subtle biases that bypass CME regulations. For example, positive studies on a company’s drug may be selectively cited over those of competing drugs; serious adverse events may be glossed over while lesser ones are emphasized; or the prevalence or severity of a condition treated by a company’s drug may be exaggerated. These biases are difficult to identify but can create powerful impressions that change clinical practice.
Moreover, it is reasonable to infer that drug companies fund CME because they receive a favorable return on investment. It would not be in a company’s interests to provide CME with content at odds with their business objectives. Including company logos would not alter biased content, but logos would remind readers that a commercial interest is at stake in the CME.
The ACCME states “disclosure and transparency have always been — and will always be —fundamental values of the ACCME.” By prohibiting logos, is the ACCME prioritizing the appearance of “separation of promotion from education” over actual separation? It can be argued that the ACCME is banning obvious promotional markings so that CME doesn’t look like an advertisement that pushes a particular drug. Funding source disclosures are easy to miss; often they are essentially footnotes. Prohibiting a company’s official “stamp of approval” on sponsored educational activities further obscures corporate influence from physician audiences. Why not highlight the fact that a CME activity is commercially sponsored instead of trying to hide it?
It’s hard enough for physicians to find education that is free of financial conflicts-of-interest. (PharmedOut maintains a list of pharma-free CME here.) The least the ACCME can do is make it easier for physicians to exercise professional judgment when deciding which CME activities to pursue.
We represent PharmedOut, a Georgetown University Medical Center project that promotes evidence-based prescribing and researches pharmaceutical marketing techniques that compromise that goal. On this issue, we find ourselves unlikely allies with the Pharmaceutical Research and Manufacturer’s Association (PhRMA), the pharma-funded CME Coalition, and pharma advocate Thomas Sullivan, who wrote in his Policy and Medicine blog that “corporate logos are an important means of ensuring transparency to the learner.” The CME Coalition said, “utilizing the logo . . . makes the distinction between supported and unsupported education apparent.” We couldn’t agree more.
Nicole Dubowitz is the project manager for PharmedOut, a Georgetown University Medical Center project that advances evidence-based prescribing and educates health care professionals about pharmaceutical marketing practices. Maggie Infeld, M.D., is an intern at PharmedOut. Adriane Fugh-Berman, M.D., directs PharmedOut. Dr. Fugh-Berman is a paid expert witness at the request of plaintiffs in litigation regarding pharmaceutical marketing practices. Ms. Dubowitz and Dr. Infeld have no conflicts of interest.