This past summer Senator Kohl Chairman of the Senate Select Committee on Aging requested information on Continuing Medical Education (CME) practices from several companies in preparation for his unbiased hearing titled: Medical Education Higher Learning or Higher Earning. Since then his staff has been releasing information they collected on a relatively selective basis.
During this investigation Senators Kohl’s Committee determined that Merck/Schering Plough (MSP) spent roughly $60 million on CME programs on Cholesterol Management from 2004 through 2007.” The document was first reported by Jared A. Favole on Dow Jones newswires.
In addition to providing the information to Dow Jones (Which we have since learned were provided to the Aging Committee from the Senate Finance Committee as public record) the information also ended up in the hands of CardioBrief a blog maintained by the former editor of Theheart.org, who says he was able to view the documents submitted to the senate committee, “the vast majority of the grants are relatively small– in the $1,000 – 5,000 range– and generally cover grand rounds and other similar activities.”
What Senator Kohl’s office is attempting to make an issue over, was that some grants were much larger, such as a grant for $5,029,723 that was made out to the Health Science Center, which at the time was a private CME provider for a “3rd Party CME Initiative (Part A).” Seemingly, what also surprised these critics were that some of the larger grants were also provided to private, for-profit medical education companies to support symposia or similar online or print programs.
This type of funding should not come as any surprise whatsoever because even as Mr. Favole noted in his WSJ article, “representatives from the ACC and from Merck noted that Merck Schering Plough (MSP) had no control over the content of the programs.”
In fact, ACCME specifically states in their standards for commercial support, and followed by largely all CME providers, content decisions are made free of control of commercial interest, supporters cannot have any control or affect in determining what content is used for courses, presentations, and so on. Moreover, many of the larger grants also went to organizations like the AHA, ACC,
The question that critics like Senator Kohl need to ask themselves is how one educates a physician truly an “ethical” issue? It is my view that this should be about medical evidence – what works for the patient, saving lives.
In the case that Senator Kohl and others tried to highlight, treating the root causes of cardiovascular disease including cholesterol, has brought down the death rate from cardiovascular disease around 40% over the last forty years and life expectancy is up considerably as well.
When a CME program is doing well, that should not indicate any ethical problems with the company providing the funding. What it should and does prove is the opposite: results for patients are so outstanding based on the training and experience physicians receive from CME programs. These programs supported by companies that may be spending $15 million a year to pay support CME is a price tag well worth paying.
Just ask any of the millions of families and Americans affected by cardiovascular disease each day.
Moreover, if programs supported by MSP were actually doing something wrong—ethically, legally, or medically—where is the evidence? The numbers and death rate is not increasing or going in the opposite direction are they?
Editors who criticize CME and industry like JAMA, IOM and Carlat hold to a religious tenant that companies can develop drugs but should not be involved in marketing or education. That is not only absurd, but a basic violation of free enterprise and capitalism, which are especially crucial to business and industry that actually saves lives. If politicians believe that companies should spend billions of dollars taking risks to develop life saving drugs, and hope that one day a busy doctor on his 15 minute rounds hears about their drug or device, they need a reality check. If all communication with physicians stops then there will be no new drugs and devices.
Asking companies to put in all the work and money into medical breakthroughs, and then leave it alone is akin to telling a politician to announce his candidacy, and then prevent that candidate from speaking in public events or meeting constituents so that voters can do their own research on them.
We know what the results are of CME programs: they reduce death rates, they instruct physicians how to use new devices and perform surgeries, and they keep doctors updated on the latest breakthroughs in clinical studies for drugs and treatments.
The payments CME providers receive to host these programs, and the funding industry provides shows companies commitment to educating healthcare providers. There is no conflict in providing the materials and resources necessary to educate physicians how to save more lives and to treat patients more effectively because industry has no control over the content.
The only ethical conflict we see is critics telling our doctors what they can and cannot learn about how to help us (government run healthcare). Companies have an ethical responsibility to support education so physicians properly use their drugs and devices to understand and treat diseases. CME is essential in providing this education to physicians to properly use such products. Americans must ask themselves is less education better for the doctor who will prescribe you treatment for your next illness or surgery?
Disclosure: I am a principle in Rockpointe and the Potomac Center for Medical Education which have recieved grants from Merck Schering Plough for CME programs.
Re: your comment that “Editors who criticize CME and industry like JAMA, IOM and Carlat hold to a religious tenant that companies can develop drugs but should not be involved in marketing or education.” This is an overstatement. JAMA certainly supports companies marketing their drugs, otherwise they wouldn’t accept drug ads. I too, support good healthy marketing in the form of ads, exhibit booths at meetings, etc…. Education is a different kettle of fish, and should be left to the profession.
You seriously misrepresent the point I made in my blog CardioBrief when I wrote that “the vast majority of the grants are relatively small– in the $1,000 – 5,000 range– and generally cover grand rounds and other similar activities.” You conveniently gloss over the fact that the vast majority of the actual money went to large grants to large CME providers who have a conflict of impossible that is impossible to manage, given the large sums involved.
I won’t enter here and now into a discussion of the many additional errors of fact and logic in this posting, but I publicly challenge you (following my private invitation which you ignored) to debate this issue. We could easily arrange a blog-to-blog debate.