by Larry Husten, Ph.D.
A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don’t need to be a Washington policy wonk to discover that there’s a huge problem with CME.
Just walk into the lobby of any major downtown hotel when a large medical conference is in town and you will see big cardboard posters advertising “satellite” symposia (”satellite” because they orbit but are not an official part of the main conference). Unless you are a doctor the title of the sessions won’t mean anything to you, and the big, boldface names of doctors featured prominently on the posters will be unfamiliar.
To doctors attending the medical meeting, however, these topics will be relevant to their clinical practice, and the speakers will be rock stars in their field. A top doctor at one of the major medical meetings can make tens of thousands of dollars during the course of a few days at these satellite sessions.
The physicians in the audience receive CME credits, which are necessary for their continuing certification to practice medicine. Somewhere prominent on the poster will be a phrase saying that the symposium is sponsored by a major medical school or hospital. But, in much smaller type at the bottom of the page will be another phrase: “this educational activity is supported by an independent educational grant from” a large pharmaceutical or medical device maker.
Satellite symposia are only the most visible arm of the CME industry. At medical schools and hospitals, in print publications and online, physicians can find endless sources for “free,” industry-supported CME. According to data presented at the Senate hearing, CME is a $2 billion a year industry, and at least half of the funding now comes from commercial sources.
Critics of the system have argued that the educational content is just a cover for the real purpose of these symposia: industry spends more than a billion dollars a year on these programs because they help the companies market their drugs and devices. Defenders of the system say that numerous safeguards put in place in recent years guarantee the independent educational value of the programs.
It will not be easy to simply throw out the current CME system, and there is no current consensus on an alternative system. But most people would probably agree that greater transparency is necessary. This could be achieved, like so much else these days, through an internet website. The site, CME.Gov, would be run by the National Institutes of Health and would serve as a central repository of all significant information for CME programs. It would require all CME supporters, producers, and participants to fully disclose complete information about the funding and the content of their programs. No CME credit could be earned unless all the required information about the CME program were first registered on CME.Gov.
The model for this site is a similar website run by the NIH, ClinicalTrials.Gov, which now carries important information about nearly all clinical trials in medicine. Although it initially met with considerable resistance when first proposed, ClinicalTrials.Gov has now achieved nearly universal acceptance and respect. By providing a high degree of transparency in an extremely contentious area, ClinicalTrials.Gov has helped defuse some (but by no means all) of the more explosive controversies regarding medical research.
It seems clear that any money that goes to medical education should be completely disclosed– by the companies that are the ultimate source of funding, by the medical schools and organizations that provide CME accreditation, by the production companies, and by each and every individual faculty member, with additional reporting of expenses and production fees, including money spent on food, entertainment, and travel. Further, all content from the CME programs– slides, articles, audio/video tapes– should also be fully accessible on the site.
The advantage of CME.Gov is that it would bring much needed transparency and openness to a system that has too often been accused of lurking in the shadows. Transparency is not always a virtue, of course, but when it comes to medical research and medical education it is absolutely indispensable.
As Louis Brandeis said, “sunshine is the best disinfectant.”
Larry Husten is a writer and editor of CardioBrief.org.
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All industries use corporate support to further continuing education. There should not be a ban on that. If we are going to cut the communication between the industry and professionals, then how on earth the new technologies can be introduced to professionals. The fight to prevent influencing the minds of physicians is going too far. Now we want the industry and physicians not to even see each other??? Does it not sound like the Taliban… too orthodox? I am a physician and I want to know what is going on in the healhcare industry. I want someone to tell me what new medicines are coming out of pipeline into the market. I do not have time to research it myself. Just because a physician saw it in a seminar does not mean they will not use it judiciously. Even ACP and other conferences have sections where they allow healthcare industry to show case what they got. Those who do not want to know the latest technology are actually doing a disservice to their patient. For example a recent drug was introduced in the market as an alternative to allopurinol for gout. I would not have known about it for many months, unless a drug rep had not come in and told me about it. I still write allopurinol, but in the back of my mind I know I have a second medicine to help my patients, if they need it.
Industry and Professional communication is very important for overall development of technology. The users have to be told what tools they have. Once we are out of school those opportunities are limited. There is just too much to do than just browse every single medical journal to see whats new out there.
Every single day the fast food companies advertise on television and ask our children to eat cholesterol laden food which will make them obese. Every single day marketeers are ruthlessly selling a lot more harmful stuff to everyone including us. We should focus on that, rather than just be trapped in our own world of medicine and to cut communications inside it.
I don’t think you’ve really responded to the point of the article. Although I am no fan of industry support of continuing medical education, my article does not propose banning or even limiting commercial support for CME. Instead it proposes that all industry support be fully disclosed on a public website. So this particular debate is really about transparency. I would be curious to learn your thoughts about this idea, and not other ideas proposed elsewhere. Let’s stick to the subject.
Transparency for who? What is this massively expensive ordeal of having to document every single dollar, participant, material and session actually for? Who do you envision going to this website and why? It brings “transparency” to who paid for your local general surgeon’s CME. But it’s a pretty safe bet that nobody in your community cares in the slightest whether it was US Surgical or Covidien.
This sounds like a large amount of annoying paperwork for a web site nobody will ever go to. Thus I fully expect the government to jump all over it and mandate it within a year.
I’m a little skeptical about the utility of such a proposal. I’d be a bit more interested in seeing a similar website for lobbyists and our congressmen.
Alec: I feel more confident in my proposal if the best argument against it is that no one is really interested in transparency. Clearly a great many people are interested in it, as the demands for increased transparency have been building in so many areas of life. Of course, cockroaches always run from the light. What are you afraid of?
I see no inherent reason why CME.gov needs to be particularly expensive to run or require much annoying paperwork.
Nuclear fire: I completely support your idea for a similar website for lobbyists! I see no reason why the two ideas should be mutually exclusive. In fact, they are part of the same broad movement for greater transparency mentioned above.
Just for S&G’s, does anyone, anywhere, have evidence (remember evidenced based medicine?) that CME requirements do anything to improve clinical outcomes, reduce malpractice, or otherwise do anything positive for the delivery of health care in America? If not, then the whole shebang should be discontinued, and the rest of the country should follow New York, Vermont, and Colorado in abandoning CME requirements. Then, we don’t have to worry about transparency, corporate influence, or any other perceived conflicts of interest.
I would imagine that the national boards of the docs in the states not requiring cme’s will still want them to maintain board certification. How is that handled and has there been any adverse outcomes trends in these states since implemented? I would imagine almost to a certainty that there have been no negative impact with the suspension of the requirements.
This is referred to as ‘disclosure’, which is mandated by the ACCME (Standard 6 in the ACCME Standards for commercial support). ACCME regulations demand that this information be disclosed to the participants, or the provider loses their accreditation. These standards have been revised repeatedly in the past few years because of the corporate influence you’re talking about.
Your proposed web site should probably be renamed HealthCareCE.gov, since most health professionals are required to take CE. The information could then be provided by the ACCME, ACPE, ACEP, AOA, ANCC, AAFP, and other groups offering CE accreditation. None of them are government entities.
I would think, though, that even with smaller type, the physician would be more likely to see the disclosure on the brochure, CE company’s Web registration site, or at the conference than on some government Web site he/she already has no time to visit.
I don’t think the website should REPLACE current disclosure but serve as an ADDITION to current disclosure requirements.
I could see the usefulness of such a site, especially since it could help identify focal areas of commercial interest and reveal potential areas of abuse. I’m not certain such a site would be possible in the near future, since Congress seems to be having enough trouble deciding where to spend our taxes.
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