According to a recent article in the New York Times, Stanford today will “announce plans to develop new continuing education programs for doctors that will be devoid of drug industry influence.”
As is the case for most media accounts of continuing medical education (CME), the article makes an exaggerated claim that industry influence has “often permeated” developing CME courses. The author however cites no evidence to this assertion, and does not suggest any alternative sources for funding these state mandated and heavily accredited courses.
The article reported that a $3 million grant was given to
Consequently, NYT noted that Stanford plans to use the money “to set up unbiased programs of postgraduate education.” The article tried to assert that these new programs will be different than “the industry-selected topics of the past” by trying to paint them as biased because they were presented “to rooms full of doctors at hotels and resorts.”
That is of course unless you are Stanford University who according to their CME website are conducting CME programs in such hardship posts as The Grand Hyatt Resort and Spa Poipu Beach Kauai, Hawaii and The Big Sky Resort, Big Sky Montana. Aren’t these resorts, perhaps the rooms aren’t full?
Such a claim by Stanford is problematic because ACCME Standards for Commercial Support clearly outline already that any funding from a company or industry to an accredited CME program cannot have any say whatsoever in the content being presented. Moreover, the fact that programs are being held in hotels only reflects the need for a large area to manage hundreds of physicians and presentations, as well as a geographically accessible area for doctors in rural and low population areas to be able to attend.
The article quotes Dr. Pizzo “criticizing the drug industry for poisoning educational programs with marketing messages and doctors for “complicity” in taking speaker fees and expenses-paid trips.” As we have noted numerous times, CME programs are prohibited from marketing any particular drug or device at accredited programs, and only discuss the clinical and research data associated with a particular treatment. Additionally, the fact that physicians take speakers fees and expenses-paid trips are no different than physicians being paid to testify at court.
David J. Rothman, a professor and president of the Center on Medicine as a Profession at Columbia, was quoted in the article as “surprised” that Pfizer would “give money with no strings attached” and stated that “I don’t know many more times they will give money with no strings attached. A $3 million grant from Pfizer with no strings attached should come as no surprise considering all grants tied to CME from industry are prohibited from marketing or control of content under ACCME standards. In addition, many drug and CME companies have already installed new guidelines with similar standards.
Accordingly, “Pfizer in a statement, said it wanted to help redefine how continuing medical education was financed to ensure the independence and patient benefit of the programs, which most doctors are required to take to maintain their state medical licenses.”
Even with a strong statement such as this, NYT still claims some still see “inherent conflicts in the Pfizer connection.” It is hard t see how anyone could see a conflict is problematic, especially when Stanford has declared it will use the grant “to focus on areas that need improvement, such as diabetes, cardiovascular disease, smoking cessation and infections.” The university also “plans to use advanced technologies, including a simulated hospital, rather than lecturing.”
Critics claim that because “Pfizer has major products in two of the four areas that the Stanford press release suggested might be pursued: smoking cessation and heart disease,” that the grant is ‘conflicted.’ They also point to a $2.3 billion settlement last year for government fraud charges of deceptive marketing for promoting off-label uses for the pain drug Bextra. While such a case should not be ignored, the issues did not directly involve CME.
While other opponents of industry funded CME believe that industry influences topic selection, tone of presentations and advice given to doctors, the fact still remains that drug and medical device companies have paid more than half the total cost of the programs. Also there is no evidence that industry which no longer sets the tone is somehow biased.
Without such funding, where will doctors be able to take CME courses to keep their license and accreditations? More importantly, where will doctors learn about the new drugs, treatments, and devices if the industries and company’s making these life saving technologies cannot teach them to anyone?
Dr. Arnold S. Relman, a former editor of The New England Journal of Medicine, a Harvard professor emeritus, goes as far as stating that for medicine “to be independent and trusted,” taking money a drug company under any conditions should be avoided.
In 2008, Pfizer “became the first drug company to say it would no longer provide such money directly to profit-making medical education companies, but only to universities and other nonprofits.” Similarly, in September 2008, “the Stanford medical school became the first in the nation to stop accepting industry financing for specific topics in postgraduate educational programs. It will accept only industry money that was pooled in a general fund for the education programs.” This does show that this announcement by Stanford may not be quite as rigid as Stanford had originally made it out to be.
Ultimately, Stanford noted in a press release: “The Pfizer grant comes with no conditions, and the company will not be involved in developing the curriculum.” Critics who construe such a statement to show the potential for conflict are misguided.
The article includes quotes from four industry critics and no proponents. The critics are playing their hand showing that in reality they oppose industry supported CME under any circumstances.
Stanford and Pfizer should be applauded for this collaboration and finding a middle ground. Despite Stanford’s anti industry rhetoric, their example should be a testament to the media and public about the confidence industry has in fueling research in academic medical centers for the purposes of better patient care.