At the AMA meeting in Chicago on Sunday, the Reference on Constitution and Bi-laws heard testimony on the Council for Ethical and Judicial Affairs report (CEJA Report 1-A-09) Financial Relationships with Industry in Continuing Medical Education.
Overall there was concern in the language even by several of those who stood in support of the measure on the use of the language used to classify CME. The main concern was around the use of the wording ethically preferable and ethically permissible.
The Council for Medical Specialty Societies offered their support of the measure if those definitions (ethically preferable and ethically permissible) were dropped in favor of a pre-amble, and in place of ethically preferable, CME providers can take steps to virtually eliminate perceived conflicts of interest in the following manor, and in place of ethically permissible, ethical guidelines for CME providers receiving industry support… They also pointed out that no other CEJA reports or opinions used that language.
The mix of speakers and states both for and against showed that this is still a very controversial report in the house of delegates.
Rising in support were:
· ACOG which outlined their strong ethical guidelines,
· AAFP which is overall supportive of the report and emphasized that conflicts need to be managed
· New York which wants to see CEJA pass but move on
· California stated the train is moving so we have to jump on it.
· Another NY Physician who stated the report is appropriate and not prescriptive
· Several CEJA and Council on Medical Education members stood up in support their comments included:
o CEJA report does not negate need for industry relationships
o The language is not arbitrary and the report is good.
Rising in Opposition and to refer back to committee:
· Pennsylvania – expressed that where one gets their CME support is business decision not an ethical one
· American Association of Clinical Endocrinologists who stated that this report will be viewed as a standalone report and with reverence from the medical community, and that they do not believe that commercial support of CME is an ethical problem
· American Association of Neurosurgery noted that they have strong eithical guidelines in place they also have problems with the terms “overly reliant” as vague term. They rely on industry to help provide equipment for teaching their members on procedures.
· Texas saw the language as vague and that it was more of an ethical procedure vs. espousing principles which could be followed.
· The Endocrine Society stated the AMA should put forward principles not regulations
· American Academy of Pediatrics was concerned with the language and what “modest reimbursement and overly reliant” meant.
· Facial and Plastic Surgeons brought up that there is no gradation on ethics
· North Carolina there is a need for industry to help with education, especially on cutting edge topics
· ASCO the report is in conflict with the Accreditation Council for Continuing Medical Education (ACCME)
· Florida discussed how you can’t label ethical grades
· Alliance for CME brought up the ambiguity in the language “ethically preferable and permissible”, and the problems with the “overly reliant and modest financial interest”
· Coalition for Healthcare Communication – offered their support if the CMSS clarifying amendments were accepted, and offered a clarifying amendment to replace “not overly reliant on funding from industry sources” to not overly reliant on a single commercial supporter or other source”
· Society for Surgery of the Hand noted that there are already rules in place to resolve conflicts of interest in the ACCME Standards of Commercial Support and we don’t need another report.
· One surgical society noted that they would not be able to afford access to millions of dollars in equipment provided by industry under the proposed guidelines.
Update
The AMA Reference Committee on Constitution and Bi-Laws recomended that despite strong objections from the membership that the report be adopted by House of Delegates. On Monday when the reference committee reports were made available, the report was extracted from the consent calandar and rejected by the full house.