Urban myths come in all shapes and sizes. Recent medical scares include a rogue politician claiming that a vaccine is no good, based on someone they met in the audience who was not trained in medicine or science. How many physicians know patients who are scared of taking a medication or getting a needed procedure based on an Internet story or a friend of a friend?
Recently, there has been controversy around whether the American Medical Association (AMA) has voted to ban pharmaceutical and device companies from supporting continuing medical education (CME). Though there have been conflicting stories, the AMA and their members still believe that industry plays a strong role in supporting CME. Moreover, it is simply an urban myth that what the House of Delegates voted on included no commercial support for CME activities.
Stakeholders in the CME community and health care industry at large should recognize an important statement AMA Council on Judicial and Ethical Affairs (CEJA) made in their report:
… relationships between medicine and industry—such as pharmaceutical, biotechnology, and medical device companies—have driven innovation in patient care, contributed to the economic well-being of the community, and provided significant resources for professional education, to the ultimate benefit of patients and the public.
It is hard to believe that CEJA could make such an affirmative statement of industry’s positive role in medicine, science and CME, and suggest at the same time that they want to eliminate industry-physician collaboration in CME.
The CEJA 1-A-11 report entitled, “Financial Relationships with Industry in Continuing Medical Education,” states:
In some circumstances, support from industry or participation by individuals who have financial interests in the subject matter may be needed to enable access to appropriate, high-quality CME. In these circumstances, physician-learners should be confident that that vigorous efforts will be made to maintain the independence and integrity of educational activities.
In a recent presentation, a representative of the AMA dispelled the myths of CEJA. He asserted that industry support is ethically acceptable when there is a demonstrated need, the activity requires high-cost resources, the decision to seek/accept funding is independent and prospective and the decision making (from the grantee’s side) is transparent.
The CEJA report puts in place many checks and balances that all align with the current Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support.
Another myth from CEJA is that faculty teaching the CME should have no financial relationships (such as being on speaker’s bureaus) with drug or device companies.
The CEJA recommendations states that,
… permitting individuals who have a substantial financial interest in the educational subject matter to participate in CME only when their participation is central to the success of the educational activity; the activity meets a demonstrated need in the professional community; and the source, nature, and magnitude of the individual’s specific financial interest is disclosed.
During the presentation referenced earlier, the AMA representative stated that it is a myth that CEJA prohibits participation by anyone who has financial relationships with industry. The goal of CEJA was straight forward: they just don’t want CME programs to rely on conflicted experts.
Participation by conflicted experts is ethically acceptable when, dissemination of device/technique/technology will benefit patients, public, professional community, and the activity meets a demonstrated need.
Now, I may not be the expert on documents coming out of the AMA, but can any reasonable person interpret this as a ban on commercial support or speakers who have worked with industry? I encourage you to read the recommendations yourself and come to your own conclusion.
So now you have it. According to the AMA, industry plays an important role in supporting medical education, especially when there is a demonstrated need and the experts participation benefits patients and the professional community. The great CME programs you as practitioners have so greatly benefited from, including access from the worlds best experts, will not be going away any time soon.
What critics frequently fail to recognize or acknowledge is that commercially supported CME has proven benefits in many areas, including but not limited to COPD, hypertension, ICU patients, sepsis, and hospital acquired infections. Moreover, a recent survey found that 89% of physicians valued industry grants to support CME because such programs provide knowledge or skills helpful in their practice and information about medications to treat particular conditions that is up-to-date, timely, useful, and reliable.
In addition, three recent studies from last year produced substantial data that demonstrate a lack of commercial bias in industry-sponsored CME (Cleveland Clinic, Medscape, and UCSF). Moreover, I know of no evidence to date showing that commercially supported CME has harmed any patients.
Myths often need to be quelled. So next time, before they tell us to off the lights, let’s make sure we have a path going forward.
As a point of disclosure, I am a principal in a medical education company, Rockpointe, and am proud of the programs we create with the support of industry.
Thomas Sullivan is founder of Rockpointe who blogs at Policy and Medicine.
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