Continuing medical education (CME) of physicians has become “an insidious vehicle for the aggressive promotion of drugs and medical devices,” US Senators have been told.

“CME has largely evolved into marketing, cleverly disguised as education,” Dr Steven Nissen, chairman of the Department of Cardiovascular Medicine at Cleveland Clinic, told a hearing held on Wednesday by the Senate Special Committee on Aging. “Amazingly, 50% of CME funding, about $1.2 billion, comes from companies who market pharmaceuticals and medical devices. Essentially, the marketing divisions of drug and device manufacturers now dominate a substantial proportion of physician education,” added Dr Nissen, who is a past president of the American College of Cardiology.

According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion during 1998-2006, and “large corporations do not typically spend these sums unless they think they will get something out of it,” said the Committee’s chairman, Democratic Senator Herb Kohl, at the start of the hearing, which is the fourth in a series held by the panel to investigate the financial relationships between drug and device makers and US physicians.

Sen Kohl asked: “Are the drug and device industries getting a return on their annual billion dollar investment in medical education? Do the programs funded by industry stay true to their mission of providing unbiased education and research, or do they instead market the industry’s latest products?”

“We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered,” he told the hearing.

According to Lewis Morris, chief counsel in the Office of Inspector General at the Department of Health and Human Services, the surest way to eliminate commercial bias in CME is to eliminate industry sponsorship by funders who have a significant financial interest in physicians’ clinical decisions.

The current environment tolerates industry sponsors’ preferential funding of programmes that serve the business needs of the funders, and, as a result, industry-sponsored CME “almost exclusively covers topics related to commercial products, instead of broader discussions of patient care,” he told the hearing.

However, in written testimony submitted to the Committee, the Pharmaceutical Manufacturers and Research of America (PhRMA) points out that the quality of any informational programme turns in large part on the expertise and skill of the presenter, and it is therefore natural for companies to seek out the most qualified physicians to address attendees at company speaker programme events, and also for CME providers to turn to many of these same experts to serve as faculty in such activities.

The consequence of imposing a restrictive policy on healthcare providers would be that either: - physicians no longer serve as speakers for companies, which eliminates an important source of information about products for physicians; or - physicians choose to continue to contract with companies to serve as speakers and no longer serve as faculty for CME activities, warns PhRMA, adding: “either result is a loss for physician education and ultimately impacts the healthcare patients receive.”

“Physicians should be free to help educate their peers in the context of company speaker programmes or CME, as long as the message being delivered in each forum is accurate and not misleading and otherwise complies with the applicable laws or rules governing the event, and the audience is provided with clear disclosures about the speaker’s relationship to the company funding the event,” the industry association's letter tells the panel.

- Sen Kohl is cosponsor, with Republican Senator Chuck Grassley, of the Physician Payments Sunshine Act (S 301), which would require the pharmaceutical and medical device industries to publicly report payments and gifts to doctors. Identical provisions are included in the health care reform discussion documents released by the Senate Finance Committee, and similar requirements also appear in the House tri-committee health reform bill.