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Errors and Omissions in NEJM Article

March 22, 2012

Errors in NEJM Article

Today we are going to talk about the issues, errors and omissions in a New England Journal of Medicine editorial on CME Several of our past blogs have identified the continued confusion between accredited CME and other forms of education, as well as a lack of understanding about the current rules and guidelines that ensure independence in CME.

Issues with Sources

The first is that the editorial sights five sources for its claim, but a main source sited was completely discredited more than four years ago. The editorial states, “A series of influential reports and policy papers have recommended major new restrictions on industry funding with some proposing the complete elimination of industry support of CME.” That source is a four year old Macy’s Foundation conference report, and you may recall that the Macy Foundation flew a group of academics to Bermuda for a weekend with the goal of discrediting the grant support for CME. The ACCME, the ACPE, as well as the ANCC analyzed that conference and its report and here’s what they concluded: “Neither the conference, its observations, assumptions, conclusions, or its recommendations seem to be based on the facts.” To quote a report that has been so discredited is not only bad science, but it is misleading.

Outdated Opinions

The NEJM article is based on outdated opinions that are no longer valid. A lot has changed in CME over the past five to seven years. There is new ACCME accreditation criteria, and there are updated standards ensuring that conflicts of interest are both disclosed and resolved prior to any CME activities. There are also content validation requirements that ensure independence. Still, the editorial provides quotes that are based on outdated opinions. The editorial states: “The existing system provides incentives for developing symposia focused on drug therapy, so as to attract industry sponsors.” However, the evidence simply shows that this is false. Several major societies in the last few years have completely revamped their guidelines for satellite symposia, including ASCO, ASH, as well as the American Heart College of Cardiology. In addition, the facts show that the number of symposia and the funding for symposia have actually dramatically declined in the past several years. So, there are in fact no incentives for developing these types of symposia mentioned in the editorial.

Contradicts Science

Now lastly, the NEJM article simply contradicts science, and this is probably the biggest problem in the editorial. It ignores the evidence base. The editorial states that there are issues about quality and conflict of interest related to the interests of potential buyers in CME. These are serious matters and deserve attention, but there is an abundance of evidence that is simply ignored or not addressed in the editorial. Two studies were done on this issue, the first being The Cleveland Clinical seminal study. 95,000 Physician CME participants were surveyed and 98% of them indicated there was no bias in CME that was either funded within industry grant support or not funded within industry grant support. In addition to that study, an even larger was conducted in 2009 by Medscape with more than one million physician participants. The study surveyed folks that went to CME activities that were funded with CME grants from the pharmaceutical industry, and those that went to activities that were not funded with grant support. Out of a million participants, less than 1% indicated any bias in either type of activity. In fact, more of the participants of the non- industry funded CME indicated that there was more bias in those when compared to those that were funded. This leads us to the question of why scientific journal editors would disburse the NEJM reputation with an editorial that has so many errors and omissions. Some readers have speculated that they are looking for more ad revenue from pharmaceutical organizations, after all the NEJM website states, “it is the cornerstone of advertising for medical marketers.” Perhaps the NEJM is unaware that CME has radically changed for the better since 2007, or as one reader speculated: “Perhaps the editors are a little bit scared that journals are threatened by more online transparent sources such as Wikipedia, and perhaps they may go the way of Encyclopedia Britannica, which recently announced, no more print additions.” Whatever the reason, physicians and CME stakeholders simply deserve better. If the NEJM cares about good science, look for a retraction or clarification in the coming weeks. As always if you have any questions about this issue or any other issues about CME, feel free to contact us here