"This may sting a bit": cutting CME's ties to pharma.

A recent proposal to address conflicts of interest in academic medical centers suggested that industry support of continuing medical education (CME) activities should be limited to contributions to a central fund that would disburse the money to programs accredited by the Accreditation Council for Continuing Medical Education. The authors of the proposal reason that this arrangement would " permit the central repository and the ultimate recipients of funds to remain free from influence by any one donor company " [1]. We would go further: only CME activities that are entirely free of pharmaceutical industry funding should qualify as education. The superficially appealing but fundamentally flawed " pooled donor " solution seeks to preserve access to pharmaceutical funding while restraining donor influence on educational content. But the assumption that blending competing conflicts somehow cancels the conflicts out does not bear close examination. Medicine is a profession, and pharmaceutical marketing is a business. The obligation of physicians is to patients; the obligation of a pharmaceutical company is to shareholders. The interests of medicine and pharmaceutical manufacturers are not congruent. The collegial relationship between the two would undoubtedly cool were physician signatures not a prerequisite for prescription drug sales. Physicians are considered by the industry to be a barrier to surmount; in an article called " A Medical Publisher Reminds Us: Don't Forget the Gatekeepers, " aimed at the pharmaceutical industry, the author tells drug execs that prescribers " stand between the consumer and your drug " [2]. Gifts have been shown to create obligations. Indebtedness to pharmaceutical manufacturers as an industry rather than to individual companies merely renders the obligation less visible—and more decorous, perhaps. It is in the interests of all pharmaceutical companies to engage in disease mongering by expanding diagnostic categories so more people are eligible for drug treatment and to convince physicians that drugs are the only viable therapeutic options. While physicians who receive CME funded by a corporate coalition may not be subjected to presentations promoting specific drugs, the " Drugs-R-Us " model of medicine is still reinforced. Diet, exercise and other nonpharmacologic approaches to disease prevention and treatment will continue to be marginalized.