Developing an instrument to measure bias in CME

Takhar, Jatinder; Dixon, Dave L.; Donahue, Jill; Marlow, Bernard; Campbell, Craig; Silver, Ivan; Eadie, Jason; Monette, Céline; Rohan, Ivan; Sriharan, Abi; Raymond, Kathryn; Macnab, Jennifer

doi:10.1002/chp.110

Cited by 24 publications

(23 citation statements)

References 12 publications

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“…Given that commercial influence is often subtle, a single binary question may fail to fully capture the range of learner perceptions of commercial influence 25. Moreover, learner perceptions of bias may not precisely correspond to actual bias in CME activities.…”

Section: Discussionmentioning

confidence: 99%

Commercial Influence and Learner-Perceived Bias in Continuing Medical Education

Steinman¹,

Boscardin²,

Aguayo³

et al. 2010

Academic Medicine

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Purpose Few studies have directly examined the relationship between commercial support of CME and perceived bias in the content of these activities. Methods Cross-sectional study of 213 accredited live educational programs organized by a university provider of CME from 2005–2007. We used a standard question from course evaluations to determine the degree to which attendees believed that commercial bias was present. Next, we used binomial regression models to determine the association between course features that may introduce commercial bias and the extent of perceived bias at those CME activities. Results The mean response rate for attendee evaluations was 56% (SD 15%). Commercial support covered 20–49% of costs for 45 (21%) educational activities, and >=50% of costs for 46 (22%) activities. Few course participants perceived commercial bias, with a median of 97% (IQR 95%–99%) of respondents stating that the activity they attended was free of commercial bias. There was no association between extent of commercial support and the degree of perceived bias in CME activities. Similarly, perceived bias did not vary for 11 of 12 event characteristics that we hypothesized might introduce commercial bias, or by score on a risk index designed to prospectively assess risk of commercial bias. Conclusions Rates of perceived bias were low for the vast majority of CME activities in our sample, and did not differ by the degree of industry support or other event characteristics. Further study is needed to determine whether commercial influence persisted in more subtle forms that were difficult for participants to detect.

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Section: Discussionmentioning

confidence: 99%

Commercial Influence and Learner-Perceived Bias in Continuing Medical Education

Steinman¹,

Boscardin²,

Aguayo³

et al. 2010

Academic Medicine

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“…Review articles were analyzed with a validated instrument for monitoring bias in CME [56]. The Takhar instrument consisted of 13 questions (see Table 1), with scores graded on a scale from 1 (strongly disagree this paper displays bias) to 4 (strongly agree this paper displays bias), or N/A (not applicable).…”

Section: Methodsmentioning

confidence: 99%

Obesity, the Endocannabinoid System, and Bias Arising from Pharmaceutical Sponsorship

McPartland

2009

PLoS ONE

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BackgroundPrevious research has shown that academic physicians conflicted by funding from the pharmaceutical industry have corrupted evidence based medicine and helped enlarge the market for drugs. Physicians made pharmaceutical-friendly statements, engaged in disease mongering, and signed biased review articles ghost-authored by corporate employees. This paper tested the hypothesis that bias affects review articles regarding rimonabant, an anti-obesity drug that blocks the central cannabinoid receptor.Methods/Principal FindingsA MEDLINE search was performed for rimonabant review articles, limited to articles authored by USA physicians who served as consultants for the company that manufactures rimonabant. Extracted articles were examined for industry-friendly bias, identified by three methods: analysis with a validated instrument for monitoring bias in continuing medical education (CME); analysis for bias defined as statements that ran contrary to external evidence; and a tally of misrepresentations about the endocannabinoid system. Eight review articles were identified, but only three disclosed authors' financial conflicts of interest, despite easily accessible information to the contrary. The Takhar CME bias instrument demonstrated statistically significant bias in all the review articles. Biased statements that were nearly identical reappeared in the articles, including disease mongering, exaggerating rimonabant's efficacy and safety, lack of criticisms regarding rimonabant clinical trials, and speculations about surrogate markers stated as facts. Distinctive and identical misrepresentations regarding the endocannabinoid system also reappeared in articles by different authors.ConclusionsThe findings are characteristic of bias that arises from financial conflicts of interest, and suggestive of ghostwriting by a common author. Resolutions for this scenario are proposed.

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“…In our initial developmental study, we found that Phase I content review was able to distinguish between biased and unbiased events; 8 however, inter-rater reliability between content reviewers was not assessed. In addition, our initial reliability study demonstrated evidence of good internal consistency (Cronbach's α = 0.82) and good inter-rater reliability (intraclass correlation or ICC = 0.67) among a small set of raters.…”

Section: Bias Management Processmentioning

confidence: 98%

“…In addition, our initial reliability study demonstrated evidence of good internal consistency (Cronbach's α = 0.82) and good inter-rater reliability (intraclass correlation or ICC = 0.67) among a small set of raters. 8 In the current study, reliability among multiple raters who were located across a variety of centers and were trained using distance education technology was assessed.…”

Section: Bias Management Processmentioning

confidence: 99%

“…In 2007, we published our first study on developing an instrument to measure bias in CME and demonstrated that the tool was both valid and reliable 8 when implemented in an efficacy setting where the standards for training and implementation were tightly controlled. In this study, we assess a revised version of the instrument in a real-world effectiveness setting.…”

Section: Introductionmentioning

confidence: 98%

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