Banning industry sponsorship of CME has wide ranging repercussions

Should drug and device makers fund continuing medical education courses?

That’s a question medical schools and academic medical centers have recently been grappling over.

Now, the University of Michigan has taken the controversial step to completely divorce the industry from physician education.

According to the New York Times,

the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses …
… Dr. James O. Woolliscroft, dean of Michigan’s medical school, said leading faculty members “wanted education to be free from bias, to be based on the best evidence and a balanced view of the topic under discussion.”

But not everyone’s happy about this trend. The American Heart Association and the National Institutes of Health, for instance, are opposed, saying, “it would unfairly cut physicians off from scientific knowledge.”

Those on the other side say that industry sponsored courses are biased, and sway doctors towards more expensive therapies that may not be always necessary.

Whatever the case, if the industry doesn’t support CME, doctors and medical schools are going to have to pay for it. That means higher course fees for doctors — which will hurt physicians who do not have a CME-allotment as part of their benefits.

Medical societies also won’t be happy, as their conferences will be more expensive to run.

There has to be a solution short of a total ban, because with the CME industry a billion dollar business, there’s simply too much money at stake.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

Comments

http://egavilan.wordpress.com/ Enrique Gavilán
Naming the industry sponsorized courses as “CME” is a falacy. Most of the courses funded by industry are nothing more than a mere marketing strategy.
It´s clear that nonsponsorized CME will lead physicians to pay their courses fees, but the sponsorized CME activities are overbudgeted.
Greetings from Spain
madoc
Absolutely not. We have been making big mistakes by letting the drug companies in the front door, and the back door. In fact I am against seeing drug reps, and taking anything from them. This is one of the serious problems that we have gone along with. Of course it will be painful to change, but what SHOULD we do.
Panacea
A way to address the issue is to look at the quality of the courses themselves. Of course, Big Pharma is going to say their treatment is the best. A requirement that information in courses be evidenced based may help curb the worst abuses, but it will take discipline from the Boards of Medicine to enforce.
CME’s, as well as nursing CE’s, are big business. Some are high quality. Some are nothing more than “CME/CE mills.”
The real point is the CME has to be about improving knowledge. If Big Pharma can’t do that without pushing its products, how valid are their claims, really?
And while money does drive this industry, it could survive without it. It just would require more locally run efforts, which has its own advantages if you think about it.
Marc Gorayeb, MD
Biases abound in all directions. From therapeutic nihilism, to insistence that generic medications are the best option for the vast majority of patients, to believing that automated peritoneal dialysis is not worth the expense over the standard method.
Independent-minded people should recoil at the idea that someone ‘holier’ than us will decide for us what information we will be allowed to have, and under what circumstances. Feel free to shine a spotlight on the abuses as they occur. Beyond that, please don’t assume that we are too feeble-minded to do the right thing.
Doc99
OK let me be the Devil’s Advocate here … we NEED money to produce CME courses – annual meetings, etc. Where are those dollars coming from? Moreover, isn’t it a bit hypocritical that folks in Congress who take far more Lobbyist money than any physicians’ group should complain about industry sponsorship of cme. No, the government will mandate cme, prohibit industry sponsorship, and force yet another Unfunded Mandate down our throats. And you can pry that Viagra pen from my cold dead hand.

madoc
Doc99
Good comments. Are you talking about not fighting back. Because if we don’t fight you will be right. At this time we are facing a huge problem and I am not sure anything can be done. We have let the people with the gold in charge. We still know deep down what is right for medicine but we are not showing it.

madoc
Well, this is turning out to be a good one. If you are a doctor who believes that certain serious problems exist with drug companies then you must act today in some little way to fight back. Otherwiise we will just be talking until we are slave/docs. If you take a small action in the right direction, you will feel good about yourself, today.
http://fertilityfile.com IVF-MD
Why must big bulky meetings be hailed as the only way to get CME? I prepare lectures to teach medical students. I organize local journal club meetings. I read a lot on my own. I attend national meetings. But I only get CME credit for the very last item even though I certainly don’t learn the most from it. Who made up this system anyway?
http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.
It is not necessary to eliminate every potential conflict of interest. Some of our most knowledgable physicians and investigators work with industry. Industry has served the medical profession and the public well. If all medical speakers and journal authors will have to be as pure as Ivory Snow, then will the most qualified and knowledgable folks be excluded? Would you rather hear a lecture by a thought leader and pioneer on the subject, who may have industry ties, or from a conflict-free speaker who knows much less about the issue?

madoc
Dr. Kirsch—somehow I just haven’t seen what you are talking about, down in the trenches.

http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.
@Madoc, not sure I grasp your point. I think that the crusade to expunge all industry connections with education can easily go too far. There’s a spectrum here, not all or none phenomenon. I don’t want speakers or writers to be quarentined on the basis of potential or minor financial relationships. There are other biases to be considered. What about an ideological bias of a speaker who has no financial conflicts? Might this not taint his presentation?

http://www.twitter.com/alicearobertson Alice
I know the Cleveland Clinic was sued on both sides of this issue. One lawsuit involved doctors who stood to profit from implanting devices in patients, and another one was recently reversed when a doctor who wasn’t not rehired sued (I think that one was about his research and ability to make money off that research). It’s online (cleveland.com), but some doctors just refuse to disclose how they make extra money…….which puts them in the same league as our political representations and pharmaceuticals. I believe the Clinic is trying to get disclosure from doctors to place the info online…..but I am really not sure how much disclosure is necessary. I am not sure where the line is drawn at our knowing about where their extra income comes from.
madoc
Dr. Kirsch
My point is—-drug companies sell drugs, they don’t educate doctors.

Concerned academic
It should be no surprise that it is the marketing arm of the pharmaceutical industry that doles out the funds for CME. They do it for the influence and access. It doesn’t have to be explicitly biased content but rather a cozy relationship between the CME producers and the industry.
Second point. The current model of CME is not proven to be effective or to alter physician practice. Young physicians are used to the “just in time” availability of information are much more likely to adapt to a technologically based CME system where you “pull” the information when you need it, rather than wait for a conference and have it “pushed.”
KP Internist
Why does healthcare costs so much in America? Someone has to pay for the sushi trays and the celebrity guest speakers. I wonder what a patient who is sitting in the “donut hole” thinks about this odd debate about whether industry should be allowed to fund CME.
ninguem
Pharma money is evil. Unless it’s coming to me.
…….pharmacy benefit managers, HMO execs, and politicians.
http://www.twitter.com/alicearobertson Alice
Pharma money is evil. Unless it’s coming to me… [end quote]
Ha!! Indeed……..most feel that way about government money too……maybe there should be disclosure on that also ….like our reps putting it on their websites who paid for their vacations, and every contributor.
http://egavilan.wordpress.com/ Enrique Gavilán
Appetite for Instruction. Why Big Pharma should buy your doctor lunch sometimes.
Especially funny is the vignette that illustrates the article: http://ht.ly/27Y7t

http://www.twitter.com/alicearobertson Alice
In the book How Doctors Think Dr. Groopman has some stories and the one in particular I am thinking of went far beyond the lunch analogy given in this URL. It becomes downright manipulative if a doctor doesn’t want to play the game (realizing doctors with that type of integrity are few-and-far between, but one doctor absolutely refused and the games start). It’s far hard to turn your back on incentives.

drhawk
the problem with this is that CME is mandated by the state boards, and in a time of rising taxes and declining reimbursements, how are we supposed to pay for the cme that we need? At my income, I barely scrape by every month, budgeting another 1 to 2 thousand that CME would cost is beyond my means, as well as many of my partners. We rely on some funding to come from big business to help pay for this. I would think that at some level, somebody would understand that as physicians we have been trained to think critically, separate the wheat from the chaff so to speak, and for the most part wold not be influenced by something a drug red or company said, just because they were paying the bill.
If you (the american public and the academic/political docs who come up with these requirements) dont think we can critically think, then you should not have us in a position to provide patient care..
I think that we are on the verge, medicine in general. Almost but not quite at the point where those of us in the trenches, providing the daily care, are about to say ‘enough’, throw up our collective arms, and just leave medicine. CME might become another step closer to this oncoming reality.

Banning industry sponsorship of CME has wide ranging repercussions

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