The Coalition for Healthcare Communication and the leading CME professional organization of private CME providers, the North American Association of Medical Education and Communication Companies (NAAMECC), issued letter to the AMA urging delegates of the American Medical Association to revise or reject Report 1 of The Council on Ethical and Judicial Affairs: Industry Support of Professional Education in Medicine
Here is a summary of the letter:
We read with great interest the recent. We appreciate and support several of the report’s summary statements regarding education, including:
• The need for physicians to “maintain their clinical knowledge and skills through continuing medical education and other professional development activities.”
• The need to “sustain ongoing, productive relationships with the pharmaceutical,biotechnology, and medical device companies” in order to “promote continued innovation and improvement in patient care,” and
• The requirement to “provide clinical training which ensures that current and future generations of physicians are competent and caring.”
While the Council, NAAMECC and the Coalition share several mutual goals, they requested that the report and its specific amendments and recommended changes be referred back to CEJA for significant modification, because of critical concerns with accuracy and validity in three main areas, as follows:
1. The report findings promote a significant misunderstanding and confusion regarding the dramatic differences between certified CME and other non-certified “education” cited.
The report terms a variety of activities as “professional education” such as “industry marketing and promotional activities, personal expenses associated with attendance at meetings, educational travel grants for medical students, free lunches…These activities are lumped in with certified CME (Continuing Medical Education), when in fact they are significantly different. The report concludes that since, for example, receiving a free lunch looks like it might affect a doctor’s professional judgment, we should eliminate any connection between companies which are set up to make a profit from medical communication and innovation and training medical professionals.
The report appears to ignore the fact that commercially supported, certified CME is managed by professionals whose organizations must comply with ACCME (Accreditation Council for Continuing Medical Education) accreditation requirements.
2. The report includes possible misinterpretation and/or misuse of data and conclusions, especially regarding the few instances of data that specifically address certified CME.
The CEJA report cites three studies implying that commercial support for continuing education is bad for the system. Two of them pre-date the ACCME Standards for Commercial Support of CME activities. While the initial Standards for Commercial Support were developed in 1992, the report cites a 1988 study stating that physicians prescribe a company drug more often “after attending a company-supported CME event.” The CEJA report also cites a 1986 study stating that CME programs “give more favorable treatment to company products” than other programs.
(Note: Even these two reports scarcely seem like a reason to make a sweeping financial and policy change. For instance, in terms of the 1988 study, is it possible that the doctors prescribed a drug more often because they became aware of its benefits; and hadn’t been before? Would we prevent a seed company from supporting an agricultural innovation seminar because following the seminar more farmers were aware of the yields from that particular variety of seed?)
However, the “smoking gun” report used by the CEJA states: “One study estimated that for every $1.00 industry spent on CME programs and other meetings yielded on average $3.56 in increased revenue.” Yet the study cited has very little to do with certified CME.
In fact, the figures quoted in the study cover “Physician Meetings & Events,” which include such non-CME activities: teleconferences, videoconferences, third party: (conducted by a moderator) focus groups or personal interviews. The study cited never mentions the term “CME” in any of the “Physician Meetings & Events” listed. The study objectives are to “measure the ROIs for detailing (DET), direct-to-consumer advertising (DTC), medical journal advertising (JAD), and physician meeting & events (PME).” It is clear from the list of PME’s that these include marketing meeting and promotional education activities that are not, in fact, certified CME activities.
3. It offers no alternatives.
The report lacks a detailed proposal to insure the proposed elimination of $1 billion in certified CME funding would improve the quality of certified CME.
I encourage you to read the full letter.
But it might be more appropriate to say: “Will this change really improve medical care and increase the spread of innovation?”