Continuing Medical Education: Keep the Best and Brightest Teaching

Earlier this year, an article in the Archives of Internal Medicine examined the “Future Directions in Industry Funding of Continuing Medical Education.”  The article attempted to assert that industry support of CME has “prompted concern that the medical profession has lost control over its own continuing education.”

Harry Pellman, MD, from the Department of Pediatrics at Edinger Medical Group & Research Center, noted that while the article summarized much of the current debate surrounding industry support of CME, it left unanswered questions: 

• Is there evidence that involvement of industry in medical education interferes with health care provider education or the quality of care patients receive? Marketing of products may influence health care provider product use, but does use of newer, frequently better products result in better or worse patient outcomes?
•  Does restricting direct healthcare provider– industry interaction, questioning, probing, and exposure worsen or improve patient care delivery? 
• If we are to sever CME ties with industry, will peer reviewed journals sever advertising? 
• Has the recent reduction in industry funding of CME programs resulted in improved patient outcomes? 
• Have critics of CME-industry relationships attended speaker training programs or CME-sponsored events? Why do they not seek the input of those that have intimate knowledge of these programs? 

Dr. Pellman has been a CME Chair of an American Academy of Pediatrics (AAP) Chapter for over 20 years, a member and Co- Chair of an AAP District CME Committee for over 20 years, and both a CME and non-CME industry–sponsored educator.  He was on the speakers’ bureau for the vaccine divisions of Merck, Novartis, and Medimmune. 

He asserted that, “provider-delivered education has deteriorated,” and that, “teachings institutions, the Food and Drug Administration (FDA), and industry must reverse this trend.”  Accordingly, Dr. Pellman offered some recommendations to address the current environment of industry supported CME. 

First, Dr. Pellman recognized that teaching and research institutions have prohibited many of the brightest, best educators from developing educational materials during sponsored events. Consequently, he asserted that these institutions could better serve the medical community by encouraging their brightest to be more, not less, involved in all aspects of education, including those that are industry sponsored.

Universities and academic medical centers have begun to create policies prohibiting faculty and staff from participating or working with industry supported CME programs. Besides having constitutional implications such as freedom of speech and association, such policies are extremely problematic. 

This essentially creates a ban on truthful information, and leaves doctors blind to data and information, which they are trained to asses and evaluate objectively. This trend, as Dr. Pellman rightly asserts, must be changed.  Doctors need this information and need to work with industry and to engage in a dialogue with their peers. And the data shows that doctors value the educational and clinical information they receive from industry. So why should we prevent doctors from participating and teaching? Medicine will never advance and patients will continue to suffer the more we keep our doctors in the darkness. 

Second, Dr. Pellman acknowledged how the FDA has restricted what a speaker can say during an industry-sponsored event. To resolve this issue, Dr. Pellman maintained that the FDA must allow more liberal disease state information dissemination in these programs. 

Finally, Dr. Pellman asserted that, “industry should increase the funding of unrestricted educational grants and prevent marketers from developing educational slide decks.” 

He noted that, “teaching faculty and speakers should be the sole developers of educational programs, although marketers and regulatory personal can attend the slide development process.” This is a reasonable recommendation and should be heavily considered by companies.  Policies such as this already exist within the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support.  And considering most companies are members of the Pharmaceutical Researchers and Manufactures Association (PhRMA) and adhere to their Code of Ethics, this change would be fairly simple. 

While skeptics point to the few cases of faculty being influenced by the products they are getting paid to discuss, Dr. Pellman recognized that his “experience in over 20 years of involvement in education shows that good faculty love to teach and will only teach what they believe.” 

Discussion 

In response to Dr. Pellman’s first question, to date, we are unaware of any evidence that shows that industry supported medical education interferes with health care provider education or the quality of care patients receive.  Physicians voluntarily choose to attend industry supported education because they find value in such programs and physicians are clearly aware of the source of the information and potential for bias and marketing.  

Consequently, while such programs have the potential to encourage use of newer products, there is no evidence that such use violates the proper standard of care or results in poorer outcomes for patients. More importantly, use of newer products is not what is driving up health care costs, considering medicine accounts for only 10 cents out of every dollar spent on health care. 

Second, while we are not aware of any studies regarding restriction of provider-industry interaction worsening or improving patient care, there is one simple way to answer this question. People are still dying from cancer, HIV, and heart disease.  Millions of patients are still suffering from chronic diseases such as diabetes and hypertension.  

While advances over the past several decades have improved outcomes in these areas, these issues are still prevalent, and restricting healthcare provider-industry interaction will only worsen patient care delivery because it will prevent doctors from learning about the newest clinical data, treatments and breakthroughs. 

Ultimately, Dr. Pellman’s recommendations are positive and should be heavily considered by FDA and all the stakeholders in the CME community. More must be done by industry to continue supporting CME and to ensure that many of the provisions and programs within health care reform are realized and achieve their full potential.  CME has the ability to improve patient outcomes, reduce costs, improve efficiency, and enhance prevention.  It is time CME providers and supporters begin fulfilling these goals.