Extremely Low Rates of Bias Reported in Commercially Supported CME Activities

The American Journal of Medicine (AMJ) recently produced a critical study titled: “Low Rates of Reporting Commercial Bias by Physicians Following Online Continuing Medical Education Activities.


The study of over 1,000,000 physician CME participants, found very little reporting of bias (less than 1%) and no difference between bias reported in commercially supported vs. non supported CME activities.


The study was funded by Medscape, LLC, and written by employees of Medscape, and other authors who give a complete list of their disclosures in the article.




According to the study, researchers provided post-activity CME evaluation surveys to analyze reporting rates of bias, overall and by funding source. Physician participants completed CME activities’ evaluation surveys on www.medscape.com. The data reflect the total number of participations in CME activities, not the total number of unique physician participants in Medscape activities.


Surveys assessed participants’ bias perception by asking if, “The activity was presented objectively and free of commercial bias,” with 5 answers: Strongly agree, Agree, No opinion, Disagree, or Strongly disagree. These answers were then separated based on whether CME activities were “commercially supported or “not commercially supported.”




With 1,064,642 postactivity survey evaluations, only 39.5% were commercially supported, while 60.5% were funded by other sources (e.g. government, non-profit).


Total, there were 3,137 activities completed by physicians, 28.3% of which were commercially supported and 71.7% not commercially supported.


58.6% of activities with bias reports were not commercially supported.


Less than 1% of physician participants in the online continuing medical education activities report bias, either overall or among commercially or noncommercially supported activities.


Only 0.63%, of responses Disagreed or Strongly disagreed with the idea that “The activity was presented objectively and free of commercial bias,”


The differences in reporting rates of bias were small between commercially supported versus noncommercially supported activities.


The top 10 activities with the highest rates of bias reports included 3 commercially supported and 7 noncommercially supported activities across 10 specialties


Overall, and for commercially supported CME, about 44% of respondents Strongly Agreed that “The activity was presented objectively and free of commercial bias.

These data demonstrate that about 93% of physician participants affirmatively claim to perceive no commercial bias following online CME activities, over 99% if no opinion is included, overall and regardless of funding source.


Future Research

While AMJ points out limitations in their study, “these data provide much-needed information to address concerns about commercial bias in CME, and are consistent with available peer-reviewed publications on physicians’ perception of bias in commercially supported CME that indicate that most physicians do not believe that commercially supported CME is biased or creates bias in their prescribing behaviors. (See sources 2, 18, 19, 21 in the article).


Although a 65.7% response rate seems low, over 1.5 million surveys were completed. As one of the first studies of its kind, such a large number of data should be applauded. The response rate does not necessarily suggest a higher bias rate than observed but, it could merely mean one of many things: physicians not having the time to complete the survey, incompatible software, inadvertently closing a program, and so on.


Other suggestions that the survey is limited because it only studied online CME are also overstated. The only other study similar in size from over one million total live event CME participants with 83% from activities with and 17% from activities without commercial funding, found results similar to those reported by AMJ. Further limitations are outlined in the study.




While concern about bias in CME and court cases against CME activities may have strengthened the widespread perception that the Accreditation Council for CME standards are not sufficient to guarantee professional objectivity in CME, at present, however, analytic study data are sparse. In fact, “a recent academic review, commissioned by the Accreditation Council for CME, identified only 10 evidence-based articles that address the relationship between commercial support and CME, none of which directly determined if commercial support produces bias.


As AMJ correctly acknowledges, “CME is essential for health care providers to remain current to provide the best care for their patients.” Just because increased funding by commercial interests has contributed to a wider offering of CME activities over the years, this investment does not suggest biased and inherently conflicted relationships between pharmaceutical companies, physicians, and the medical education enterprise as critics suggest. Rather, such an increase in funding represents the primary goal of the health care industry and CME providers: contributing to better patient care and outcomes through evidence-based clinical studies and collaboration with government and academic entities.


Requests for reprints should be addressed to Julie Ellison, PhD, Medscape, LLC, 370 Seventh Avenue, Suite 1101, New York, NY 10001. E-mail address: jaellison@medscape.net


American Journal of Medicine: “Low Rates of Reporting Commercial Bias by Physicians Following Online Continuing Medical Education Activities.” Volume 122, Issue 9, Pages 875-878, September 09

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