A recent article by Harry Pellman, M.D. entitled The importance of bias in education dispels some of the myths about pharmaceutical company involvement in physician education. With 22 years of chairing the CME Committee of an active American Academy of Pediatrics (AAP) Chapter and co-chairing the CME Committee of an AAP District, Pellman notes that he’s had “intimate interactions with hundreds of nationally recognized speakers, some with and some without industry affiliation.” He writes: “Myths, frequently perpetuated by those with little or no real-world contact with these programs or by people with anti-industry bias and peppered with words like ‘perceived’ and ‘potential conflict,’ need to be corrected.”
Pellman’s article looks at a few in particular that individuals who work in industry or are involved in continuing medical educational have come across. He writes:
Myth: Faculty with a pharmaceutical relationship are inferior to faculty without this relationship. They are privy to much more data, have frequently been involved in the product research, often freely duel with industry scientists and others about the data generated and how the information needs to be disseminated, interact with others researching the topic, and present newer, not-yet-published information (and disclose this) to attendees.
Myth: Education is better off without the pharmaceutical industry. At a time when medical knowledge is rapidly expanding, and it is becoming increasingly more complicated, and greater dissemination of the latest, best information is desperately needed, pharmaceutical financial support can help. Pharmaceutical support allows us to invite – free of charge – all University of California, Irvine-Children’s Hospital of Orange County pediatric residents and U.C. Irvine medical students to every CME program. Industry restrictions already in place are sufficient to promote more educational opportunities and less-expensive attendee costs. No new restrictions are needed.
Myth: Only faculty without industry relationships are unbiased and should be allowed to influence policy regarding education. This nasty, modern-day expression of “McCarthyism” attacks those with industry relationships, dismissing their contributions, intelligence, and sincerity with the “of course they support so-and-so; they are being paid by industry.” A 5-year evaluation of CME programs sponsored by California Chapter 4 AAP from 2009 to 2013 reveals the following data: 23 CME programs, 24 of 55 speakers listed a potential conflict of interest (44%). There were 1,995 attendees and 1,370 returned a response on whether or not a commercial bias was in the presentation; 1,342 responded “No” (98%) and 28 responded “Yes” (2%). Although almost half of the faculty had a potential conflict, only 2% of attendees felt their presentation suggested a commercial conflict. Interestingly, some of the “yes” responses were for faculty with no conflict to disclose.
How are these myths started and in many cases perpetuated? Pellman looks to a comprehensive journal review regarding industry-academic relationships in four influential journals published over the last few decades.
Of the 108 published articles the study looked at, only 12 were either neutral or emphasized some benefit. Of these 12, all addressed the opposing points of view, and 50% critically emphasized and attempted to refute the alternative points of view. On the other hand, however, 16 research articles (15%) emphasized the risks of a relationship with industry, and none critically analyzed and attempted to refute the alternative points of view. The majority, 80 (74%) were commentary articles that emphasized the risks of a relationship with industry, and only 7 articles critically analyzed and attempted to refute the opposing points of view.
“The authors conclude that a major anti-industry publication bias exists and that a conformity cascade – where policy does not emerge from objective weighing of evidence but from social pressure – may be a factor for this major bias from medical journals that are influential in affecting policy,” Pellman writes.
He also worries that the Sunshine Act may be particularly detrimental. “Many of the few remaining academics that still have a relationship with industry will sever this relationship for fear of being a ‘target,'” he fears. Furthermore, academic institutions have restricted faculty members’ interactions with pharmaceutical scientists and other faculty. “Past speaker and advisory sessions were attended by an eclectic group of specialists and generalists, and were filled with fertile discussions and debates regarding disease and treatment perspectives,” Pellman writes. “There are no winners when these bright educators are kept away from potential learning and teaching situations.”
“Those of us interested in education need to keep an eye on the prize – educating providers so that health care is optimized,” Pellman notes. “This is best done by broadening the dialogue about how to improve and better disseminate both the quality and quantity of health care information being generated.”
“Besides, the industry that has given us medications and vaccines that have improved the quality of life for so many needs to be treated with less contempt and more respect,” Pellman concludes. “It is time to build bridges, not walls, and broaden the collaboration needed to better disseminate the vast amount of new information being generated. Improving practitioner education will need fresh ideas, an open mind, validating studies, a gentler dialogue, and the respect, inclusion, and collaboration of all stakeholders.”