Disclosure of Financial Conflicts of Interest in Continuing Medical Education Michael D' Jibson, MD,

1
Disclosure of Financial Conflicts of Interest in
Continuing Medical Education Michael D. Jibson,
MD, PhD and Jennifer Seibert, MDUniversity of
Michigan Department of Psychiatry
Abstract
Discussion
Methods
Speakers at CME conferences supported by the
University of Michigan Department of Psychiatry
were invited to provide more detailed financial
disclosures than are required by the ACCME.
Attendees at these conferences were randomly
selected to receive either the minimum
information required by the ACCME or one of two
higher levels of disclosure. The medium level
of disclosure listed companies in order of how
much money had been received from each and
whether it represented more or less than 5 of
the speakers total income. The highest level of
disclosure listed each company and the percent of
the speakers income derived from that company in
the last 12 months. Hypothetical examples are
shown below. Low (Standard) Disclosure Medium
Disclosure High Disclosure Company
A Speaker Company B Consultant gt5 Company
B Consultant 25 Company B Consultant Company
C Speaker gt5 Company C Speaker 6 Company
C Speaker Company A Speaker lt5 Company
A Speaker 1 Attendees were asked to describe
their professional training (e.g., MD, PhD, etc),
level of experience with the topic of the
conference, their satisfaction with the
disclosure they received, and their rating on the
objectivity of the information presented on a 1-5
scale, with 1 being no bias and 5 being extreme
bias. Peer reviewers with established expertise
in the topic of the conference were asked for a
similar assessment of the speakers objectivity.
Introduction Significant controversy exists as
to whether current ACCME regulations regarding
financial disclosure by CME speakers is adequate
to ensure the objectivity of information
presented, but few data are available in this
area. The purpose of this study was to determine
what level of information regarding speakers
conflicts of interest is preferred by CME
conference attendees, and whether the degree of
disclosure assists attendees in assessing the
objectivity of information presented. Methods
Three speakers at a University of Michigan CME
conference were invited to provided more detailed
financial disclosures than are required by the
ACCME. Attendees at these conferences were
randomly selected to receive one of three levels
of disclosure and were surveyed regarding their
opinions of the disclosure and the objectivity of
the program. Attendees responses were compared
with those of peer reviewers. Results All
speakers agreed to disclose their conflicts of
interest, which ranged from 5-30 of their total
income. Attendees preferred an intermediate
level of disclosure. Attendees receiving medium
and high levels of disclosure tended to rate
objectivity closer to peer reviewers. Conclusion
Higher levels of disclosure are preferred by
attendees at CME conferences and may assist
attendees in assessing the objectivity of
information presented at these programs.
Despite having significant contacts with
industry, all speakers in this study agreed to
provide detailed disclosures. The overall level
of bias in the presentations was judged by peers
reviewers and attendees to be low, limiting the
generalizability of these data. The possibility
that speakers altered their behavior after giving
detailed disclosures cannot be ruled out (and may
provide an additional mechanism to improve the
objectivity of CME programs). Attendees who
received intermediate and high levels of
disclosure rated the objectivity of CME
presentations more consistently with peer
reviewers. When averaged across all speakers,
lower levels of financial disclosure were
correlated with lower ratings of objectivity,
irrespective of the rating of peer
reviewers. Attendees receiving the intermediate
level of disclosure expressed the most
satisfaction with the information, whereas those
with the low level felt they had too little and
those with the high level too much. These data
represent the first attempt to measure the impact
of financial disclosure on the ability of CME
participants to assess the objectivity of
information provided and represent pilot data for
further study.
Results
Introduction
Future Directions
Three speakers were asked for financial
disclosures and all consented. Their level of
involvement with industry ranged from 5-30 of
their income. The survey response rate was
83.3 (135 of 162 surveys) 71.9 (97) of
respondents were physicians 86.7 (117) were
prescribers (MD, DO, PA, NP). The average rating
of bias by peer reviewers for the 3 speakers was
1.17 (range1.00-1.33). All figures compare the
responses of attendees who received low, medium,
and high levels of disclosure
Average Bias Ratings for All Speakers
Significant concern exists about the influence of
the pharmaceutical industry on the practice of
medicine. Patient opinion surveys indicate that
patients believe physicians should receive their
education from independent sources (84) and that
ties between physicians and the pharmaceutical
industry should be transparent (96).1 Extensive
research has been undertaken to elucidate the
role of pharmaceutical industry sponsorship in
the objectivity of medical journal content,2 and
guidelines for interactions with industry that
aim to eliminate competing interests have been
implemented to preserve the integrity of medical
education.3 The Accreditation Council for
Continuing Medical Education dictates the level
of disclosure of financial conflicts of interest
required by speakers at continuing medical
education programs.4 Significant controversy
exists as to whether current ACCME regulations
regarding disclosure of the involvement of CME
speakers with industry are adequate to ensure the
objectivity of information presented.5,6 Few
data are currently available to guide educators,
institutional leaders, and professional
organizations in establishing policies in this
area. This study is intended to determine what
level of information regarding speakers
conflicts of interest is preferred by CME
conference attendees, as well as to elucidate
what level of financial disclosure is optimal to
allow learners to assess the objectivity of
information. It is hypothesized that higher
levels of disclosure will be preferred by
attendees and will assist them in more accurately
assessing the objectivity of information.
A larger data set will be required to confirm
these preliminary findings. APA, ACCME, and an
independent medical education company have
expressed interest in the study and agreed to
provide support for the survey during CME
conferences they sponsor (APA has already done
so). Comparison of presentations by speakers who
are not approached for this study or who decline
to provide a disclosure with those whose detailed
disclosures are available will help determine if
the process of disclosure contributes to more
objective teaching. References 1. Eaton L.
Readers want transparency in link between doctors
and drug firms. BMJ. 3261352. 2003. 2. Lexcin J.
Bero L. Djulbegovic B. Clark O. Pharmaceutical
industry sponsorship and research outcome and
quality systematic review. BMJ. 3261167-1176.
2003. 3. Coleman D et al. Guidelines for
Interactions between Clinical Faculty and the
Pharmaceutical Industry One Medical Schools
Approach. Academic Medicine, vol 81, No 2,
154-159. 4. ACCME Standards for Commercial
Support Standards to ensure the Independence of
CME Activities. http//www.accme.org/index.cfm/fa/
Policy.policy/Policy_id/9456ae6f-61b5-4e80-a330-7d
85d5e68421.cfm, accessed 9/21/06. 5. Lemmens T,
Singer PA. Bioethics for clinicians 17.
Conflict of interest in research, education and
patient care. Canadian Medical Association
Journal. 159960-65, 1998. 6. Steward DE. A
proposal to enhance the disclosure of potential
conflict of interest for continuing medical
education events. Teaching and Learning in
Medicine. 15267-269, 2003.
h
Difference between Attendee and Peer Bias Scores
Attendee Rating of Disclosures
High
Medium
P0.004 P0.007
Low
3.0
2.5
3.5
Too Much
Too Little