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Outrage of the Month: Tobacco Industry Sponsorship of Continuing Medical Education

Health Letter, July 2024

By Robert Steinbrook, M.D.
Director, Public Citizen's Health Research Group

If you’re not outraged,
you’re not paying attention!

Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.

The website Medscape describes itself as “the leading online global destination for physicians and health care professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and CME[continuing medical education].” In a turn of events that is beyond bizarre, in March 2024 Medscape Education began to offer five accredited “smoking cessation” courses for health care professionals that were funded by Philip Morris International, one of the largest cigarette manufacturers in the world.

Not only does Philip Morris International manufacture a deadly product, but it also has a blatant conflict of interest, as it also seeks to promote non-cigarette nicotine products that it markets for harm reduction, such as e-cigarettes, “heat-not-burn” tobacco products that generate nicotine-containing vapor without smoke or ash, and oral smokeless products such as nicotine pouches and snus (a form of smokeless tobacco). On its website, the company openly states its plans: “We are building PMI’s [Philip Morris International’s] future on smoke-free products that—while not risk-free—are a far better choice than cigarette smoking. Indeed, our vision—shared by all at PMI—is that these products will one day replace cigarettes.”

The medical focus should be on ending nicotine addiction and an individual’s use of all tobacco and nicotine products, not switching to a company’s other product lines. A person who viewed the courses noted that possible responses to a question about reducing cancer risk were switching to a pipe or e-cigarettes or reducing smoking to a half pack a day, but: “Unbelievably, none of the options given include quitting smoking.”

Following an investigation by The BMJ and widespread condemnation of its partnership with Philip Morris International, Medscape Education permanently removed the courses, acknowledging that “use of a tobacco company as a program funder was misguided” and stating that it “will no longer accept funds or work with the tobacco industry or its affiliates.”

Although Medscape has removed the courses, it is even more astounding that the Accreditation Council for Continuing Medical Education (ACCME) allowed them to be accredited in the first place. When The BMJ questioned the president and chief executive officer of the ACCME, his response was that the council “doesn’t ban education content paid for by the tobacco industry as long as providers ‘follow the rules to ensure the content is protected from bias and influence, and the provider discloses the support to the learners, among other requirements.’”

When interviewed by The BMJ, a former director of the Office on Smoking and Health at the Centers for Disease Control and Prevention described Philip Morris International’s partnership with Medscape as “the ultimate example of the fox not only signing up to guard the hen house but offering to sit on the eggs.” The official added: “It is a perversion of ethics surrounding continuing medical education to allow the very companies that caused and profit from the continuing epidemic of tobacco related death and disease to be involved in any way.”

The tobacco industry is never an acceptable funder for continuing medical education. The partnership between Medscape and Philip Morris International is a wake-up call. There are many companies that offer CME and many tobacco companies. The ACCME should urgently revise its standards; tobacco industry funding of continuing medical education must end.