In response to a third report on Continuing Medical Education (CME) issued by the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA) titled CEJA Report 1-1-09: Financial Relationships with Industry in Continuing Medical Education , Stephen Lewis President of Global Education Group and the North American Association of Medical Education and Communications Company (NAAMECC) recognized that the report had some “good ideas but used bad logic.”
Mr. Lewis asserts that the report includes examples of flawed logic and non-sequiter sidebars that will greatly diminish the level of agreement and support for its conclusions. The bulk of the report’s recommendations that address “conditions” that should be met when industry funding is necessary “to ensure that physicians have access to appropriate, high quality” CME are already required and addressed by ACCME Standards and policies.
CEJA contradicts itself by expressing “concern” about independence in Certified CME when the report acknowledges that CME follows AMA and ACCME definitions, standards, and policies. The report also makes all of its claims without any “available data to demonstrate conclusively that commercial funding unduly biases continuing professional education.”
Even though they call for a ban on industry funding, CEJA confusingly admits that funding may have positive results because “it is not always feasible, or necessarily desirable, for professional education to disengage from industry completely.” They even recognize that “refusing support from industry entirely could significantly undermine the profession’s capacity to ensure that physicians have access to appropriate, high quality CME.”
Much of the growing concern about conflicts has been over ethical infractions outside of the CME arena. To date, all evidence indicting CME stems from unethical practices: three examples stemmed from federal cases alleging illegal marketing practices of the drugs Neurontin, Vioxx, and Xyrem between 2002 and 2005.
Conclusion
The new CEJA report does specifically address the link between CME and improved physician practices. Specifically, the report states that physicians “have an ethical obligation to dedicate themselves to ‘continue to study, apply, and advance scientific knowledge’ and to ‘maintain a commitment to medical education.’” In addition, the report states, “CME activities that are pedagogically sound, scientifically grounded, and clinically relevant are essential to ensure that physicians can provide the high quality of care their patients deserve.”
As a result, the media and the CME enterprise should keep a global perspective on the costs, risks, and benefits of Certified CME compared to other fields. Why? Because $880 million was awarded in grant funding from all pharmaceutical companies to CME providers in 2008. This funding enabled the development of 100,000 educational courses that educated more than 16 million healthcare professionals.
Industry CME funding improves quality, because it helps support the development of an accreditation system for compliance and professional accredited providers that thrive by demonstrating quality and developing innovative education that improves professional practice. In the absence of funding, CME would not include appropriate management or development of innovative, interactive, web-based and live presentations.
The organization without professional resources to effectively manage a CME program is the most likely one to develop poor quality CME. Funding allows CME professionals to identify and resolve faculty conflicts of interest and clinically review educational content.
Eliminating industry funding would reduce CME quality and eliminate the system of checks and balances that currently ensures relevant, evidence-based education.
If current rules and guidelines require independence, then the solution would not be to add another layer of rules and recommendations from CEJA. The most effective solution should be to enforce existing rules to the fullest.