A recent report from First Word examined “The CME Landscape – Change and Challenges.” The report addresses criticisms of the continuing medical education (CME) industry for being biased toward product promotion, and for undermining the provision of balanced and complete education to practicing physicians.
Such criticisms are unfounded because they “ignore ongoing and increased efforts to ensure independence and decrease bias,” according to the North American Association of Medical Education and Communication Companies (NAAMECC), and the Coalition for Healthcare Communication. In fact, in addition to a 14 percent reduction in total commercial support received for accredited CME, a national “survey of physicians in six specialties found that only 35 percent of physicians reported payment of costs associated with continuing medical education.” Is one out of every three doctors having CME paid for really that bad, especially when some of them were traveling at their own expense hundreds of miles away from rural areas with little access to CME programs?
Industry support for CME helps to expand knowledge and improve care. Thousands of physicians who have participated in CME with industry support and millions of patients of have benefited from the expanded knowledge and improved care.
As the report correctly acknowledges, “CME in its original intent is designed to increase disease awareness and understanding of the epidemiology, prognosis and, more importantly, the available treatment options.”
Benefits of Industry Sponsored CME
“A mutually beneficial relationship exists between physicians, CME providers, and the pharmaceutical industry in their support of CME.” As a result, commercial support of CME:
– Allows physicians to stay current in their field with the pressure of rapid advances;
– Helps create funding sources when other places (e.g. government) are uncertain;
– Lets physicians give feedback to the healthcare industry on the real-world clinical outcomes of its drugs;
– Allows the pharmaceutical companies to make greater profits, which in turn allows them to discover and market useful new drugs;
– Keeps physicians up-to-date on new drugs and therapeutics;
– Gives researchers in the best position to explain the properties of that drug to physicians;
– Creates an emphasis to keep up with the rapid rate of scientific developments and the need to improve health of the under-served and aging population; and
– Makes up for the under-funded medical colleges, non-profits, and government agencies that are unprepared to assume sole responsibility of CME.
In addition to the above mentioned benefits, ACCME has augmented its standards and guidelines to ensure the independence of commercially supported CME activities. Moreover, the AMA House of Delegates third rejection of a proposal to ban industry support from CME “shows a commitment to CME funding and academic freedom by the AMA membership, implying that AMA members are not willing to give up their rights to collaborate with industry and walk away from commercial support of CME.”
Groups such as the American Academy of Pediatrics and American Academy of Family Physicians have affirmed that existing guidelines sufficiently protect the integrity of medical education.
To support their affirmation, a recent study of over one million CME participants by Dr. Julie Ellison and colleagues in the American Journal of Medicine, found very little reporting of bias (less than one percent) regardless of the funding source. In fact, only 0.63 percent of responses disagreed or strongly disagreed with the idea that―the CME activity was presented objectively and free of commercial bias.
Additionally, as reported by Manhattan Research, only nine percent of American physicians oppose commercial support for CME funding, taken from a nationally representative sample of American physicians, including primary care and specialist audiences. The study also reported that if commercial support is halted, nearly half of the physicians surveyed would decrease their use of CME.
Mark Bard, Manhattan Research President, noted that “rather than pulling the plug on a vital source of CME funding, the primary beneficiaries of CME – physicians and patients – would be best served by continued improvements in course availability, offerings, and content through increased collaboration among medical and academic organizations, the pharmaceutical industry, CME providers, and accreditation bodies.”
Interestingly, last October, at the 20th Annual National Task Force on CME Provider/Industry Collaboration in Baltimore, 58 percent of the conference attendees said they would like to maintain the current model of funding, while just five percent wanted to eliminate commercial support. When given just two basic options— to maintain commercial support or to eliminate it—83 percent choose to maintain it.
Perception vs. Reality
Perception: If industry spends lots of money, CME has to be biased.
Reality: Dr. Melvin Scheinman from the University of California, San Francisco, noted that the programs he and many other physicians are involved in are conducted with the highest academic and professional standards. These programs teach a great deal of material through interaction with peers and fellows, and the faculty members who participate in these courses are often clinical scientists from outstanding academic centers, with impeccable credentials as both clinicians and teachers.
Perception: Faculty who participate with commercially funded CME lack integrity.
Reality: In the courses that Dr. Scheinman attended, the programs were centered on objective exposition of material tailored for trainees, as are most CME courses. He never witnessed any attempt by the industry sponsors to, in any way, interfere with the program substance or style.
Perception: Cardiac trainees can be influenced by commercially funded CME.
Reality: Based on 40 years experience, Dr. Scheinman believes that trainees are critical and should be urged to actively interact with the faculty during these courses.
If commercially funded CME is eliminated, who will foot the bill? Is prohibiting commercial funding going to help medically underserved communities, mainly in community hospitals? How will this move contribute to the dissemination of CME to those communities as physicians in these areas may find accessing and paying for CME more difficult without healthcare industry subsidies? How will the concentration of CME funds to a smaller number of entities and devaluing MECCs‘contribution lead to the elimination of bias? How can a non-commercial entity with fewer resources provide better education than a commercial one?
Commercially funded CME courses provide unrestricted grants to the CME providers, which means the role of course content or faculty selection is solely at the discretion of the CME provider. Banning industry from CME programs or all physicians who had financial ties to pharma, would deprive physicians and patients some of the most expert speakers on the topic and would have to make do with second-rate education.
As the Institute of Medicine report stated, it is not even clear how the content of CME would change in the event that pharmaceutical industry funding was removed. Consequently, doing so is problematic because physicians want to learn and be motivated alongside their peers and they want to be updated on new practices such as through participation in live activities. In fact, the report states that, a mix of cost-effective CE could be achievable in the current financing environment.
Maintaining commercial funding of CME is an easy choice because “MECCs are compliant with ACCME standards and promote high standards in patient care by adding excellence and entrepreneurship to the CME enterprise.” Moreover, “MECCs bring innovation to the educational process, including for areas such as multi-media, needs assessments, outcomes and program design.” The potential for any conflict in such innovation “can be best managed by providing full disclosure, robust reporting and transparency to the learner.”
In the end, with the number of accredited CME providers already decreasing, and further attrition expected when the ACCME shifts to its new system of collecting data in a real-time, web based system, sources of funding for CME providers must not be eliminated.
We have no financial interest in this report.