The Association of Clinical Researchers and Educators (ACRE), recently released their response to the AMA CEJA Report: Financial Relationships with Industry in Continuing Medical Education (1-I-09). Specifically, ACRE recommended that AMA House of Delegates reject the report or refer its recommendations back to committee. The report which includes some light editing from the report rejected by the House of Delegates this past summer needs to be rewritten from the beginning.
Methodology and Evidence
The CEJA report itself admits that “there is no empirical evidence to support or refute the hypothesis that CME activities are biased” (p. 3 48-49), and the available data by no means demonstrate conclusively that commercial funding unduly biases continuing professional education (p. 4 11-12). The report also admits to using an “arbitrary” methodology to define criteria that would be used to eliminate industry-funded CME is even more problematic considering the evidence CEJA uses to advance its claims.
Ignoring Relevant Evidence
CEJA’s reliance upon the Brennan paper violates a major requirement of serious scholarship by not citing research that shows the many benefits of commercial contributions to medicine. Instead, Brennan exercised confirmation bias by referring only to publications critical of industry influences on medicine, although others refuting these criticisms existed when the Brennan paper appeared.
CME Participation is Voluntary
Participation at industry sponsored CME is always a voluntary activity. If doctors choose to go it’s because they find it to be of value. They do not have to go. And when physicians do go, they know the nature of the content being presented from the disclosure and the rules governing industry sponsored CME (through the Accreditation Council for Continuing Medical Education (“ACCME”)).
Industry-Funded CME
With over 50% of CME being funded by industry, who is going to pick-up the bill if industry is banned? For the most part, the federal government does not see supporting CME as part of its mission and states are broke. Insurance companies and academic medical centers have reduced funding for CME over the last ten years. If industry funding of CME is removed, physicians will lose critical access to programs that teach them how to use new medicine, treatments, devices and technology, the majority of which is created by the same industry that support such programs.
Delayed Implementation
The CEJA recommendation on elimination of commercial support, chooses to ignore the potential for patient harm by delaying treatment if new procedures and therapies are not discussed and explored in CME activities or those activities fail to take place due to lack of support.
Rural and Inner-City Physicians benefit from CME
In these areas, it is unlikely that any outside expert would come on their own to teach other providers the management of diabetes or complex cancers without commercial support helping to cover expenses of these experts. Also, the selection criteria of having to prove that a speaker does not have a conflict is especially burdensome on smaller CME providers
Medical Societies benefit from experts
Medical Societies will also suffer from recommendation 2, in that a vast majority of new science is presented by faculty who are currently involved in compensated relationships with a commercial entity. The exception criteria will be tremendously burdensome on smaller societies who will be forced to dedicate resources to justify the use of the most knowledgeable speakers and presenters.
Healthcare Reform: More CME, Not Less
With healthcare reform around the corner, we need to consider that adding an additional 30–60 million patients to the system will force a need for additional training by physicians especially primary care physicians. Reducing the sources of funding for education of physicians will only further strain the already overburdened physician healthcare providers.
CME Progress
The commercial support which helps pay for CME enhances patient care. The death rate from cardiovascular disease, for example, the number one killer, has steadily decreased and is currently half of what it was at that time. Death rates for cancer have also decreased.
Commonality of Interests
There is no inherent “conflict” of interest in the working relationship of physicians with industry and government. Rather, there is a commonality of interest that is healthy, desirable, and beneficial. The collaborative and constructive relationship among physicians, government, and industry has resulted in many medical advancements and improved health outcomes.
CME and Industry Promote Variety
Industry-funded CME is merely one of many options physicians use to address the well being of patients. Since the purpose of medical "professionalism" is better patient care, positive outcomes of corporate investments in research, development, and promotion create a variety of knowledge and information to providers wishing to be competent to help with the patient's best interest in mind.
Industry Support of Education is Not Corrupt
CEJA’s use of the Brennan Report is oddly selective because it neglects the obvious fact that academic health centers and medical journals are also "commercial," are engaged in vigorous competition with rivals, and exhibit the same promotional behavior deemed unattractive when exhibited by private companies.
Conclusion
Ultimately, asserted that there is value to physicians, medicine, medical education, and patients from the working relationship between physicians and industry, and that there is no conflict in advancing science or in providing the education that is required to do so.
By working together with industry colleagues, ACRE believes that physicians an industry can explain to the public that the contributions of corporations to medicine are, on balance, more beneficial than harmful and that both medicine and the industries that provide it with its technologies are worthy of public support. Finally, ACRE acknowledges that by working with industry to develop and market therapies with the highest integrity, medical education will keep physicians current on the best available evidence to provide excellent patient care.
CEJA Report 1-1-09: Financial Relationships with Industry in Continuing Medical Education
Disclosure: Thomas Sullivan is a principle of Rockpointe and the Potomac Center for Medical Education a private medical education company, in addition Thomas volunteers and serves on the ACRE steering committee as a non voting member.