Medical Education Companies, Commercial Support and Transparency

Continuing Medical Education (CME) Companies have recently been targeted as being opposed to transparency in continuing medical education funding.   Let me set the record straight: This is simply not true.  

We ardently support the guidelines established by the Accreditation Council for Continuing Medical Education (Standards of Commercial Support) and the Food and Drug Administration (Guidance on Industry Supported Scientific and Educational Activities) and other organizations to ensure the integrity of continuing medical education and to insulate it from undue influence by pharmaceutical and medical device companies.   

For the companies I am involved all our programs include disclosure of funding source, disclosure of faculty and staff relationships with industry.

The 2004 ACCME standards for commercial support tightened the rules about commercial support and made them clearer and more specific about how to resolve, and disclose potential conflicts of interest, and deliver high quality commercially supported continuing medical education.

I also support disclosure of CME payments made by pharmaceutical and device companies to educational providers included in the Physicians Payments Sunshine Act, but since the medical industry is rapidly adopting greater transparency and voluntarily disclosing its payments to CME providers and individual doctors, It may not be necessary for those payments to be included in health care reform legislation now being considered by congress.

A Phony War?

What I do object to is the suggestion that commercial enterprises, be they pharmaceutical companies or medical device firms, ought to have no role in medical education.  

I call this controversy a “phony war” since the vast majority of those directly affected by medical education—the health care community—readily accepts industry participation. 

In fact, a recent study by Manhattan Research revealed that only nine percent of American physicians object to commercial support for continuing medical education (“CME”).  A recent study of over 1 million CME participants in the American Journal of Medicine showed that bias was found by less than 1% of physicians regardless of the funding source.

A proposal to purge CME of industry funding was defeated for the third time by the American Medical Association’s House of Delegates less than three weeks ago, with groups such as the American Academy of Pediatrics and American Academy of Family Physicians affirmed that existing guidelines sufficiently guard the integrity of medical education.

Yes, health care companies fund medical education related to disorders for which they have treatments.  Isn’t that logical?  But critics imply that funding programs equates with controlling content; that implication makes for riveting headlines, but it simply does not happen in practice.  

One thing to ponder is that today, it is considered by our critics as honorable for physicians and CME providers to work with trial lawyers and insurance companies which add little value to the medical system, but dishonorable to work with industry which provides significant advances in patient care.  Those fighting the “phony war”, need to be reminded of all the progress and advances in patient care that those working with industry have helped to make happen.  In fifty years, I want my children to remember that I helped to educate physicians and healthcare professionals on the latest treatments and which potentially helped saved millions of lives.

Financial Support

Private CME providers help fill an educational gap since the need for updated medical education is extremely high working alongside academic institutions and medical associations to deliver high quality medical education.  This is how the free enterprise system works.  

Critics attempt to make a case that private companies with resources dedicated to produce educational programs are somehow “corrupt” because they accept commercial financial support for their programs.  It is foolish to think however that any group–whether it be an institution, association, or private company — would not seek out all funders or sponsors that are available to them to conduct their business and to educate physicians.  The critical factor is not the funding source, but the independence and integrity of the programs offered.

Companies like ours receive grant support from industry and others to help underwrite our educational programs.  Our revenues also have expenses which include venue costs, honoraria, travel and other operational expenses including salaries, health insurance and overhead (all of which are appropriately reported) and translate into modest profit margins. 

We provide excellent medical education programs, spending significant amounts of staff time ensuring that the content is relevant to patient care, understandable to the participant and useful to medical practice. 

Physicians and other healthcare professionals willingly participate in our programs often spending large amounts of time to learn and advance their knowledge of medicine.   They have many choices so the quality must remain high, and credible for any group to be able to continue to produce CME programs.  Commercial companies that fail to meet high standards of education are forced out of business.

Continuing Medical Education: A Business Challenged

Doctors are required to continue their education and pursue CME credits because medicine is one of the most dynamic of all professions.  Perhaps no other field equals the pace of new information and in the field of CME, patients lives can depend on timely delivery of new information.

New medication strategies, new devices and new discoveries about human biology mean that health professionals must refresh their knowledge constantly.   With the avalanche of scientific developments, the requisite to improve the health of the under-served and the fierce urgency to improve health outcomes, the need for medical education has never been greater.

Medical colleges, not-for-profit organizations and government agencies are important sources of information about these new developments and provide slightly more than half of continuing medical education courses.  But they are underfunded and unprepared to assume a greater role.  In short, they are definitely not prepared to assume sole responsibility for medical education.  

The private sector health care industry is the logical source for this educational programming.   It should be monitored—and it is.  It should be transparent in its dealings—and it is.  And it should be encouraged to invest more—not less—in unbiased continuing education programming without the hectoring and suspicion that has defined recent reports.  Let’s hope that this comes to pass.


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