AMA CEJA 2009: Council of Medical Specialty Societies Recommends that CEJA Join the Process for Change

The Council of Medical Specialty Societies (CMSS) issued their comments to the reference committee on constitution and bi-laws concerning the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA) CEJA Report 1-I-09, “Financial Relationships with Industry in Continuing Medical Education.” Their response is in concurrence with the draft CMSS Code on Interactions of Specialty Societies in Relationships with Industry, which will occur November 20, 2009.

 

CMSS agreed with CEJA’s report that “medicine has an ethical obligation to ensure that the profession itself sets the agenda and defines the goals of physician education; controls what subject matter is taught; determines physicians’ educational needs; and takes steps to ensure the objectivity of educational content and of those who teach it” (p. 2, lines 27-30).”

 

They also agreed that while “there is growing concern within and outside of medicine that industry funding can have undesired effects on CME, at present there is no clear evidence to settle the question whether such concerns are borne out empirically” (p. 3, lines 42-46).” As a result, CMSS wrote that it could not support CEJA report 1-I-09 in its current form, as the report is internally inconsistent and flawed for the following reasons.

 

• In disagreeing with the CEJA report, CMSS asserted that “commercial support of CME is not unethical.” Instead, they noted that influence of commercial support “should be prohibited by CEJA, as it is by the Accreditation Council for Continuing Medical Education (ACCME), in its “Standards for Commercial Support: Standards to Ensure the Independence of CME Activities” (SCS). Specifically, content is not allowed to be controlled by commercial support of CME activities, and presently, adherence by providers to the ACCME SCS succeeds in separating industry support from influence.

 

• CMSS strongly believes that the AMA should unequivocally support the ACCME Standards and should continue the profession’s voluntary self-regulation through the ACCME SCS. If AMA does not support the ACCME SCS, it sends the message that the profession does not support its own voluntary self-regulation, opening up the profession to the natural consequence of external regulation of CME.

 

• “CEJA report violates its own warning by justifying its concerns about the influence of commercial support by referencing literature which pre-dates the first edition in 1991 of the ACCME SCS (Bowman 1986, CEJA reference 25).” As a result, calling for an end to commercial support of CME, gives the appearance of establishing ethical guidance without the evidence necessary to draw such conclusions because there CEJA does not use up to date peer reviewed and accepted evidence that such support biases CME.

 

• The Institute of Medicine’s recent report on Conflict of Interest in Medical Research, Education and Practice (April 28. 2009) does not call for an end to commercial support of CME. The extensive, interdisciplinary IOM review of relationships between medicine and industry concluded, as does ACCME, that influence, not support, should be avoided.

 

CMSS also took issue with two CEJA recommendations because of their contradictory nature.

 

• The report calls for prohibiting pooled funding from multiple sources, and in-kind use of expensive equipment from multiple vendors. What CEJA did not realize is that pooled funding is attractive in that it separates a perceived influence of a single company on a CME activity.

 

• CEJA’s recommendations already permitted the use of expensive equipment, provided in-kind by multiple vendors for training physicians in important procedures but, then prohibited in a separate recommendation. 

 

• This type of confusion highlights the types of mistakes CEJA is making that will ultimately harm patients, and keep providers uneducated about new lifesaving treatments.    

 

Ultimately, CMSS believes that it is the profession’s responsibility to society to voluntarily regulate itself, in this case in its relationships with industry.

 

Accordingly, CMSS has invited the AMA to work with them, and the 15 national organizations of the Conjoint Committee (CCCME) on a 24 month process, called for by IOM, to convene the national dialogue leading to a system of CME support.