Intended for healthcare professionals

Feature Essay

Industry-funded medical education is always promotion—an essay by Adriane Fugh-Berman

BMJ 2021; 373 doi: (Published 04 June 2021) Cite this as: BMJ 2021;373:n1273
  1. Adriane Fugh-Berman, professor
  1. Georgetown University Medical Center, USA
  1. ajf29{at}

Although awareness of individual conflicts of interest and ethical problems with physician-industry relationships has increased, few people realise just how much continuing education is used for product promotion, writes Adriane Fugh-Berman

Many countries require doctors to complete a certain number of hours of continuing medical education (CME, known as continuing professional development in the UK) to maintain a medical license.1 But CME is heavily funded and influenced by drug and medical device manufacturers. And because CME is considered education rather than advertising, no country regulates it as product promotion.

Studies analysing content have shown consistent messaging in industry-funded CME that favours sponsoring companies’ drugs and disadvantages competing products.23456789 The messages work: commercial CME affects prescribing choices. A sudden tripling in prescribing of an antipsychotic—an increase lasting at least three months—at the Minneapolis Veteran’s Affairs Medical Center was traced to a grand rounds presentation by a speaker paid by the manufacturer.10 A 1992 study found that after an all-expenses-paid CME symposium held at a tropical resort, prescription rates for the CME sponsor’s drugs more than doubled.11

Although every study designed to detect commercial bias in CME has been positive, doctors cannot detect bias. Studies that have asked doctors whether commercial bias existed in specific commercially funded CME activities have found that most detect none.12131415 Other studies have found that most doctors do not believe that commercially sponsored CME is biased in general.161718 Only one study, which surveyed Chinese doctors attending a nephrology conference partially funded by industry, found that most respondents thought that industry supported courses were biased.19

That most doctors cannot detect covert commercial bias is unsurprising given the depth to which industry messaging has become ingrained in medicine’s definition of …

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