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JAMA Article on CME bias

August 30, 2013

CME Bias

Today we’re going to be talking about bias in CME, a topic that was well addressed five years ago, and many in the CME community felt that it had been dealt with. However, an August 19th article in The Journal of the American Medical Association (JAMA) by Bernard Lo argues that a problem with bias in CME exists and needs to be further addressed. He attempts to link this bias to grant funded CME, that is, CME that has been grant funded by pharmaceutical companies. In order to determine whether this is good journalism or just finger pointing, let’s look at three of the critical points that Lo attempts to make in the JAMA article.

CME professionals spend more time focusing on conflicts of interest, disclosure and resolution than on bias in presentations

Two responses to his points here: First, Lo does not cite any research, nor does he provide any footnotes to support this claim. Lo also ignores two massive studies that were done several years ago of more than a million participants at CME activities, which amounts to thousands of hours of CME. One was conducted by a university, and the other by an online aggregator of CME. In fact, those studies both concluded independently that less than 1% of CME activities showed any amount of bias. Furthermore, one of the studies showed that non-grant funded CME activities had a slightly higher amount of bias than those CME activities that were funded by educational grants, although it was still less than 1%. Lo’s response to the facts is this: Even if the physician learners don’t report bias in CME activities, those same learners simply aren’t smart enough to detect bias in the first place. Lo also makes another hypothetical point that just simply doesn’t exist in practice.

“If drug companies were permitted to suggest or choose speakers for CME activities, they would likely select physicians that favored their products.”

While that may be true, this is specifically banned by the ACCME standards for commercial support and guidelines. Lo does actually provide some evidence in his opinion piece, although it may not be completely relevant.

“After disclosing conflicts of interest, advisors in a particular study showed that they may give more biased advice.”

The problem here is with his reference. Lo cites a study and article from the American Economic Review, featuring advisors who estimate the value of coins inside of a jar. Applicability to CME? Not seeing it. The title of this article is, “What Is the Enemy in CME, Conflicts of Interest or Bias?” Well, based on the current facts, it seems that Lo may have made up an enemy that simply doesn’t exist. The only way to analyze an argument lacking so much merit is this: Should we blame Bernard Lo for trying to make it, or blame JAMA for publishing it? As always if you have any questions feel free to contact us at any time. For Global, I'm Stephen Lewis. Have a great day.