According to a recent post at Pharma Marketing Blog, online CME has taken a toll on the standard powerpoint and folding chair affairs.  Continuing medical education (CME), which are the credits required for a physician to maintain her medical license, comes in many forms: hospital grand rounds, symposia at annual meetings, correspondence courses offered through universities, medical associations, and journals, or online courses among them. Blogger John Mack did the numbers on the Accreditation Council for Continuing Medical Education annual trends and found that pharmaceutical investment in traditional CME has leveled off, and doctors are doing more and more CME online—a trend that Mack argues allows less opportunity for ‘collateral marketing,’ by which he must mean handouts, tchotchkes, and location, location, location.

But though these data show traditional pamphlet and slideshow courses may be on the wane, the same isn’t true of pharma’s influence.  Just look at the web ads above Mack’s blog post: “7th Annual ePharma Summit” for “Pharma-marketing in the Web 2.0 World” at the Ritz-Carlton in Philly,, And it’s anyone’s guess how many more online CME brokers advertise on this page and others like it. 

Mack argues that “pharma’s return on online CME investment may be much less than for live events such as symposia at medical conferences,” but don’t be so sure.  As with online shopping—or online anything—the nature of the web makes it easier to pass something off as something else: in this case, to hide sources, support, and credentials, at less cost to those doing the fleecing.

Though in broad strokes, Big Pharma’s trickling R&D pipeline, shrinking profit margins and multi-front regulatory war make it look like a lumbering and antiquated machine, the industry in other ways moves with the deftness of a biological organism, adapting to and manipulating a quickly changing environment in real time.

The number of third-party CME companies proliferating in the brochures of annual meetings and online medical journals are evidence of the latter. 

Take the CME shop featured in Dr. Daniel Carlat’s blog post this week: a company that will provide ‘independent content validation’ for your industry CME courses. Responding to a heightened regulatory atmosphere, the service on offer, “CME Peer Review,” pledges to verify the science and “truthiness” of your CME—via a pool of other industry-backed experts.  Dr. Carlat, who has made it his mission to expose industry-backed CME—a challenge not for lack of material, but for its myriad disguises and tendency to shapeshift—flips through the materials with equal parts incredulity and admiration of the deft corporate evolution on display.  

But for every Superbacteria that crops up, the world uses more hand sanitizer: as pharmaceutical companies get more sophisticated in their methods of influencing CME, so too do those who are calling for the profession to take back the textbooks…and the seminars, and web curricula, and annual meeting symposia.

Recently, PostScript talked with a physician who regularly attends the CME series at University of California San Francisco. Last month, a course called “Marketing Medicines: Critical Skills for Physicians” caught her eye.  The course is supported through the Consumer and Prescriber Grant Program that grew out of the $430 million Neurontin off-labeling marketing settlement in 2004.  The UCSF course is just one of a series of projects intended to re-educate doctors and prescribers about the influence of pharmaceutical companies on medical practice; Dr. Jerry Avorn’s academic detailing work in Pennsylvania and Elissa Ladd’s nurse education program at MGH are others familiar to the Prescription Project.

As universities, government leaders and payers tighten their belts and restrict physician gifts and inducements from pharmaceutical companies, less overt influencing—i.e. marketing disguised as education—will undoubtedly become the locus for more and more industry attention. 

And as industry adapts to an increasingly aware medical community and skeptical public, count on the ways it gets its message into docs’ homework pile to multiply.