Industry Support and Professional Medical Associations—Reply

In Reply: Although Dr Kahn is correct in noting the absence of definitive studies demonstrating bias in commercially supported CME, the absence of such studies does not mean an absence of bias. Our recommendation reflected the now accepted finding that gifts and payments, even when small, influence physicians' beliefs and behaviors.¹ Accordingly, they are likely to influence the individuals and committees who select CME topics and the speakers who deliver them. The report of the November 2007 Macy Foundation conference noted that of the total $2.4 billion income for accredited CME activities in 2006, drug and device company support accounted for $1.5 billion, or more than 60 percent.² Similar to the conference participants, we do not believe that such levels of industry support would have been forthcoming if the companies were not convinced that their funds were enhancing “shareholder value by promoting the sale of their products.”² Finally, it is curious that Kahn presented only 2 scenarios: conflicted physicians and commercial-free CME vs conflict-free physicians and commercial CME. There is a third scenario: conflict-free physicians and noncommercial CME, which is our objective.