The American Medical Association released their 2009 Council on Judicial Affairs (CEJA) proposed recommendations to the House of Delegates on Financial Relationships with Industry in Continuing Medical Education. The AMA Council on Medical Education (CME) also released their companion report Conflict of Bias in Medical Education to the House of Delegates on the application of the CEJA recommendations.
After reviewing the subject on commercial support of CME, the AMA CEJA committee conclusions validate the importance of commercial support.
This report is in stark contrast to the report this same committee issued in 2008 but which was rejected by the AMA House of Delegates, which called for a complete ban on industry support.
According to the CEJA committee: Relationships with industry—i.e., pharmaceutical, biotechnology, and medical device companies—can offer enormous benefit to the profession and the patients it serves.
However, commercial funding for professional education can pose significant ethical challenges to medicine’s ability to focus primarily on the needs of patients and ensure quality education for physicians.
They came up with two categories of interests:
It is ethically preferable that:
CME providers accept funding only from sources that have no direct financial interest in a physician’s clinical recommendations; and that
· Individuals who program, develop content for, or teach in CME activities:
o Have no current, recent (within the preceding 12 months), or potential direct financial interest (e.g., royalties or ownership interest) in the educational subject matter; and
o Are not currently and have not recently been (within the preceding 12 months) involved in a compensated relationship (e.g., direct employment, service on a speakers bureau, service as a consultant or expert witness) with a commercial entity that has a financial interest in the educational subject matter.
It is ethically permissible that:
CME providers accept funding from industry sources if the following conditions are met:
The educational activity is planned by the provider based on needs identified independent of and prior to solicitation or acceptance of the funding; and
The use of the funding is not restricted in any way; and
The source of the funding is clearly disclosed; and
The CME provider is not overly reliant on funding from industry sources.
CME providers permit individuals who have modest financial interests in the educational subject matter to program, develop content for, or teach in CME activities if the following conditions are met:
The existence and magnitude of any financial interests are clearly disclosed; and
Steps are taken to eliminate or mitigate the potential influence of those interests.
CME providers permit an individual who currently has a direct, substantial, and unavoidable financial interest in the educational subject matter (e.g., as the inventor of a new device) to program, develop content for, or teach in a CME activity only if the following conditions are met:
The individual is demonstrably uniquely qualified as an expert in the relevant body of knowledge or skills; and
Participants are clearly informed about the nature and magnitude of the individual’s specific financial interest in the subject matter; and
There is a demonstrated, compelling need for the specific CME activity in the professional community that cannot otherwise be met; and
Steps are taken to mitigate the potential influence of the unavoidable financial interest to the greatest extent possible; and
Every effort is made to develop a pool of qualified, independent experts as quickly as possible.
CME activities that involve financial relationships which cannot be addressed through any of these mechanisms are ethically prohibited.
Most if not all of their recommendations can be implemented under the current Accreditation Council for Continuing Medical Education Standards for Commercial Support.
The recommendations require further review, and will be a topic of discussion in the coming weeks.
This report still has to be adopted under by the Reference Committee and the Full House of Delegates which meet June 13th – 17th in Chicago.
Organizations will have opportunity to comment on these reports at the AMA House of Delegates meeting.
A companion article will be published later today on the AMA-CME recommendations
AMA CEJA: Full AMA CEJA Report
AMA CME: Conflict of Interest and Bias in Continuing Medical Education