Put away your books and take out a sharpened No 2 pencil. Today's CME Glossary entry is going to be a short quiz. Which of the following best match ACCME's definition of "balanced?"
1. Balanced: A fair representation of both the benefits and risks of a treatment, therapy, or medical device.
2. Balanced: A fair representation of the range of treatments, therapies, or medical devices for a particular medical condition.
Time's up! Put your pencils way. ACCME discusses "balance" in Section 5.2 of their Standards for Commercial Support. Here's what they have to say:
STANDARD 5. Content and Format without Commercial Bias
5.2 "Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the CME educational material or content includes trade names, where available trade names from several companies should be used, not just trade names from a single company."
So the ACCME definition seems to emphasize fairly representing the range of alternative therapies (Definition 2). However, I wouldn't assume that a balanced presentation of risks and benefits of particular therapies is not important. In the "Ask ACCME" section of their website, ACCME provides additional details that extend the meaning of "balance":
"A ‘balanced view’ means that recommendations or emphasis must fairly represent, and be based on, a reasonable and valid interpretation of the information available on the subject (e.g., “On balance the data support the following …”). A ‘balanced view of therapeutic options’ also means that no single product or service is over represented in the education activity when other equal but competing products or services are available for inclusion."
Since ACCME's concept of "balance" extends to "a reasonable and valid interpretation of the information available on the subject," it would seem to encompass providing coverage of both the risks and benefits of particular therapies (i.e., Definition 1).
ACCME's "reasonable and valid" standard also raises the issue of individual differences. Since different faculty can have different opinions about what is "reasonable and valid," presentations advocating strong opinions either for or against particular treatments or therapies can be considered balanced, as long as they are based on interpretations of relevant data that can be considered "reasonable and valid." Variation among different interpretations is a good reason to collect learners' opinions about balance when we evaluate our CME activities.
Can a CME presentation focus on a particular treatment or therapy? For example, a radiologist might want to do an educational presentation about the clinical use of a particular medical device. While such a presentation might be "balanced" with respect to the risks/benefits of that device (Definition 1), it might not provide equivalent detailed information about all alternative therapeutic options (Definition 2). So can it be balanced?
I think so. Notice that there is a subtle, but significant, difference between ACCME's wording in Section 5.2 and Ask ACCME. Section 5.2 states that "presentations" must be balanced, while Ask ACCME precludes the over representation of particular products or services in "educational activities." My interpretation is that Ask ACCME provides CME program managers the flexibility to allow a presentations that focus on particular treatments or therapies as long as the overall educational activity provides a balanced view of alternatives.
Case studies often highlight both a particular therapy and a particular outcome. So attaining balance for case studies can be a challenge with respect both outcomes (Definition 1) and the range of therapeutic options (Definition 2). When using case studies, we should probably make sure learners are informed how often they should expect the same result, as well as therapeutic alternatives.
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