In a move that provides no guarantee of improved excellence and performance in continuing medical education, Pfizer has announced that they will no longer fund CME through medical education companies. 

Announced via press release Pfizer Changes Its Funding of Continuing Medical Education in the U.S. and in the Wall Street Journal:  Pfizer to End Financial Support: For Commercial Doctor Classes and other publications.

According to Pfizer:

Pfizer will continue to support CME programs at many of the world’s leading academic medical centers and teaching hospitals, as well as programs sponsored by associations, medical societies and community hospitals, in keeping with the shared goal of improving public health.

Effective immediately, Pfizer is eliminating all direct funding for physician continuing medical education (CME) programs provided by medical education and communication companies (MECCs). The company will honor existing commitments.

“This move by Pfizer, to my knowledge the first among commercial supporters of CME, represents a significant advance in the profession’s ability to address the complex issue of conflict of interest,” said Dave Davis, MD, Vice President, Continuing Education and Improvement, Association of American Medical Colleges. (Um AAMC, aren’t they going to be the beneficiaries of this move)

“Continuing medical education, when done right, improves healthcare provider understanding of disease, expands evidence-based treatment, and contributes to patient safety,” said Dr. Joseph M. Feczko, Chief Medical Officer of Pfizer Inc. “We understand that even the appearance of conflicts in CME is damaging and we are determined to take actions that are in the best interests of patients and physicians.”

Pfizer’s new approach reflects its goal of meeting the highest standards for medical education, and academic medical centers, hospitals, associations and medical societies best meet these standards. For example, Pfizer will continue to support grants such as one made to the California Academy of Family Physicians in March for a three-year national healthcare professional education campaign to reduce the number of U.S. smokers. This grant was distributed among nine partner organizations, including the University of Wisconsin, a leading institution in the improvement of continuing medical education.

"The purpose of continuing medical education is to help physicians and other healthcare professionals enhance clinical care and improve patient outcomes,” said Dr. George Mejicano, Associate Dean for Continuing Professional Development, University of Wisconsin School of Medicine and Public Health. “Today's announcement sends a strong signal that educational funds must be used appropriately and that industry support is intended to fund education to improve health."

(Didn’t Pfizer just state the University of Wisconsin got a three year grant, could there be any conflict of interest here?  Imagine if the press release was on the elimination of commercial support for university CME and a MECC president like myself was quoted as saying: “Today's announcement sends a strong signal that educational funds must be used appropriately and that industry support is intended to fund education to improve health." Certainly there would be outrage by the Medical Schools including University of Wisconsin pointing out the inherant problems with such a statement)

The Coalition for Healthcare Communications issued this response:

Coalition for Healthcare Communication Position Paper on the importance of commercial providers in the CME enterprise

As a major participant in efforts to address public policy questions on conflicts of interest in medicine, the Coalition for Healthcare Communication applauds efforts at self regulation by industry partners, but fears that Pfizer's recent decision to eliminate all direct funding for continuing medical education (CME) by commercial providers is misguided and may be counterproductive.  While we agree with other aspects of Pfizer's recent public announcements intended to address much recent public criticism of commercial support, we believe commercial providers spur excellence in patient care by adding innovation, excellence, and entrepreneurship to the CME enterprise.

Despite much recent public criticism of industry supported CME, commercial providers have an unequaled record of compliance with conflict of interest rules, and provide much of the best CME available today to the nation's doctors and other healthcare providers. Pfizer's attempt to blunt public criticism feeds the worst of the misperceptions of the industry and does not address the true challenges facing doctors and patients today.

The Coalition, industry partners, organized medicine and public policy makers agree that patient care is best served by quality education from multiple providers.  Most also agree that conflicts of interests are best managed by full disclosure and robust reporting and transparency programs. Moreover, the Coalition and many others believe that patient care is best served when commercial providers are allowed to compete in the education marketplace because entrepreneurs spur innovations and competition for excellence in education as well as regulatory compliance.

Pfizer's recent decision to redirect it education grants may well depress the innovationsbrought to CME by commercial entrepreneurs over the past few decades. Commercial providers have historically been among the first to introduce new and innovative programs to the medical community Indeed, commercial providers have been willing to take the financial and other risks needed to move beyond the boundaries of traditional education in at least four areas:

1. development of interactive and multi-media techniques that actively involve the learners in programs and outcomes

2. support of critical clinical needs assessments and creation of innovative educational programs designed to meet those needs

3. focus on fostering and measurement of clinical outcomes from educational programs, and

4. development of Internet learning platforms and programs designed to address the immediate needs and time constraints facing clinicians.

Furthermore, the Pfizer decision does not recognize that commercial providers are the leaders in regulatory compliance. 

Indeed, these entrepreneurs currently are  uniquely qualified,  staffed and otherwise equipped to create and implement the developing compliance and reporting functions demanded by policy makers and the public.

This is particularly true given extensive and increasingly complicated regulatory oversight, transparency and reporting requirements facing the industry. Indeed, because conflict of interest compliance so far has been largely focused on commercial support from industry and commercial providers, commercial providers lead the industry in compliance. 

By contrast, the commercial conflicts faced by medical schools, hospitals and similar providers are just beginning to be recognized and addressed, and thus transparency and other compliance programs are in their infancy.  Shifting the burden of regulatory compliance to these institutions without mature compliance systems will not serve Pfizer, organized medicine or patient care.

We stand proud of the record of commercial providers of CME, and continue to believe that patients are best served when all provider types — including commercial providers — are allowed to fully participate in the enterprise and are subject to the same oversight by government and self-regulation institutions, including the FDA, HHS-OIG, and the ACCME. 

It is interesting to note that an interview published today in Medical Meetings, Mike Saxton the Senior Director and Team Leader of Continuing Medical for Pfizer stated:

"We are eliminating support for commercial CME providers, whether they are for profit or nonprofit, and regardless of whether they have firewalls.”

In the same interview Saxton states:

“MECCs’ role is critical. Patients would clearly lose if MECCs were not part of the equation. They’re innovative, they’re efficient, and they have competencies that other provider groups often lack. The best model for MECCs is to collaborate with hospitals, associations, and academic medical centers."

Saxton clarifies that this move is not a blanket condemnation of medical education and communication companies. "Some of the best providers out there are MECCs and some of the worst are MECCs, so it is unfortunate that this action will not allow us to give direct support to quality MECCs.”

Contrary to Pfizer’s own press statement stating Pfizer spent about $80 million last year on CME courses offered by companies and nonprofit organizations alike, Ms. Clary said, with less than half going to for-profit companies. 

Saxton stated that up until this announcement, Pfizer had awarded 17 percent of its CME funding to medical education and communication companies in 2008.  So let's do the math, 17% of roughly 6 million of CME grants infirst quarter, less the $3.4 million block grant is: $442,000 in grants first quater to MECC's.

It is also interesting to note that Pfizer spent around $6 million on CME grants in the 1^st Quarter, and $3.4 million going to the University of Wisconsin Consortium.  This would translate to about $24 million in CME spending for the year, significantly less than the $80 million they reported in 2007, and even that number of $80 million is significantly less than what they spent just three years ago.   

So why the announcement, why now….

Several questions need to be asked:

Many of our programs are focused towards under severed communities, many in community hospitals, how will this move contribute in the dissemination of CME to those communities?

How will the concentration of CME funds to smaller number of entities contribute to the elimination of bias?

Why does Pfizer think that a non commercial entity with less resources, provide better education than a commercial one? (what about private universities vs public?)

What effect does this move have on commercial free speech, does this limit the access to ideas?

How is devaluing the contribution of MECC’s and their dedicated employees to providing high quality education, contribute to the cause of improving quality in medical education? 

This move only serves to de-value the work of thousands of dedicated individuals who work for Medical Education and Communications Companies, who have dedicated their life work to providing high quality medical education.

Links to Sources:

Pfizer Press Release

Wall Street Journal Pfizer Ends Direct Funding of Courses

CNN Money Pfizer Ends Direct Funding of Courses

Medical Meetings “Pfizer Cuts off Medical Education Companies”

Medical Marketing and Media Pfizer sacks commercial support of CME

FiercePharma: Pfizer to Stop Funding for Profit CME

Pfizer Letter to CME Providers

Pfizer Frequently Asked Questions on New Criteria

Also as part of their press release Pfizer announced that:

To qualify for Pfizer support in the future, CME programs will have to meet revised, stricter criteria. These criteria will:

• Eliminate all new direct funding commitments for CME programs by medical education and communication companies (MECCs);
• Initiate a competitive grant review period for grant applicants to encourage more innovative, high-quality grant applications;
• Support the medical community’s call for balanced funding in CME by establishing financial caps on grant support; and
• Require all major grant applicants to meet criteria equivalent to ACCME’s highest level of accreditation^[1].
• In addition, Pfizer will continue to publicly report all CME grants provided in the U.S. at www.pfizer.com.