In its fourth attempt to soil independent CME grants provided by industry to advance competency and patient outcomes, the American Medical Association Council on Ethical and Judicial Affairs (AMA CEJA) is earning distinction for being one of the least credible sources of information in the CME enterprise.
In AMA CEJA Report #1, the authors confused Certified CME with promotional activities branded under the name “professional education.” Specifically, the first CEJA report stated that “professional education” included:
• “CME”
• “industry marketing and promotional activities”
• “personal expenses associated with attendance at meetings”
• “educational travel grants for medical students”
• “free lunches”
• “residency positions”
• “company speakers’ bureaus”
• “free or subsidized travel”
Unfortunately, the only thing on the list above that does qualify for physician credit and meet the definition for Certified CME is “CME.” Everything else is not Certified CME.
Additional AMA CEJA reports on CME continued the confusion and borrowed misunderstood ideas from other national organizations. The AMA CEJA parroted the 2009 Institute of Medicine report that created the amorphous concept of “subtle bias” in CME: an undefined bias somehow created just by the very presence of industry grant funding, even though accreditation rules specifically require independence from any promotional influence and appropriate management of grant support.
The AMA CEJA took it a step further in its third (2009) report on CME. The CEJA report stated that grant funding soiled CME content by creating both “unconscious” and “subtle bias.”
There are two important non-sequiters plaguing these “subtle bias” arguments. First, if CME bias is so subtle that physicians can’t detect it, how is it that the authors of these reports can do so?
Second, the evidence cited by CEJA doesn’t hold up. The footnotes CEJA provides to support the connection between grant funding and CME bias don’t even relate to CME activities. One article is on “gifts to physicians from industry” from marketing/sales representatives. The second is a Harvard Business Review article on the 2002 Enron scandal and financial crisis addressing “Why Good Accountants Do Bad Audits” (erroneously titled by CEJA as “Why good accountants go bad”).
In spite mounting evidence and convincing studies showing little or no connection between bias and grant-funded CME, the AMA CEJA is back at the plate, swinging against industry education grants. The 2010 report ignores both the Medscape and comprehensive Cleveland Clinic CME studies showing that 98% of physician attendees considered CME to be free of bias, whether or not industry grant funding was provided. In addition, the 2010 AMA CEJA report continues to erroneously cite and footnote information. Evidence based? Not AMA CEJA.
Ironically, a different group within the AMA appears diametrically opposed to AMA CEJA. In April, the AMA hosted National Task Force on CME Provider/Industry Collaboration produced a “Get The Facts” campaign that sets the record straight with a toolkit and series of fact sheets. This is an excellent step in clarifying what CME is and what it is not.
The four AMA hosted National Task Force Fact Sheets on CME address the following:
· CME: Providing Valid and Independent Evidence for Clinical Decisions
· Addressing Conflict of Interest through Disclosure and Resolution
· Commercial Support of CME and Compliance with Guidelines
· Appropriate Discussion of Off-Label Drug Use within CME
In its announcement of the Get The Facts campaign, the National Task Force plainly stated the perception problem we face in the CME enterprise:
“The media, state and federal law and policy makers as well as regulators and other ‘collective/consensus opinions’ frequently use and disseminate information that can lead to incorrect assumptions and false perceptions about CME. This has led to increased regulatory scrutiny and critical public opinion regarding CME practices.”
The more AMA CEJA pitches out reports that lead to “incorrect assumptions and false perceptions about CME,” the more the AMA Task Force and the rest of us have to field unfounded accusations and criticism.
After four strikes against CME without factual support, it’s time for AMA CEJA to either play by the rules of evidence or leave the ballpark. Let AMA CEJA know they are harming patients by playing games with unfounded accusations about CME support.