Elimination of industry support for CME

Something huge happened at the American Medical Association House of Delegates meeting. Although the meaning of what happened will be spun throughout the blogosphere, twittersphere, and schmuckosphere, the bottom line is that the AMA just voted most commercial funding of CME out of existence.

Specifically, the delegates voted to approve a report of the AMA ethics committee that calls for a near elimination of industry support for CME. The report is entitled “Financial Relationships with Industry in Continuing Medical Education.”

It is a 12 page report, and CME geeks like me will want to pore over every word, but the essence is found on page 8 under “Recommendations.” The third paragraph makes the intent of the AMA explicit:

CME that is independent of funding or in-kind support from sources that have financial interests in physicians‘ recommendations promotes confidence in the independence and  integrity of professional education, as does CME in which organizers, teachers, and others  involved in educating physicians do not have financial relationships with industry that could influence their participation. When possible, CME should be provided without such support or the participation of individuals who have financial interests in the educational subject matter.

What this means is that the AMA now expects that most CME courses will meet two criteria:

1. No commercial support for the activity.
2. Faculty teaching the CME should have no financial relationships (such as being on speakers’ bureaus) with drug or device companies.

The report does allow for some exceptions to these criteria: “At times it may be impossible to avoid a financial interest or extraordinarily difficult or even  impossible to mitigate its potential impact on an educational activity.” They cite examples such as courses involving the use of very expensive material, such as cadavers or sophisticated equipment. Also, they allow that in some remote parts of the country it may be acceptable to take industry money to fly out experts to teach doctors. However, in that same “exception section,” they reiterate that: “For the most part, accepting support from a company or permitting participation by an individual when there is an irreducible financial interest would not be ethically acceptable.”

What happens next? Since the AMA literally defines “AMA PRA Category 1 Credit” for the ACCME, any company that deviates from the recommendations of this report will be non-compliant with ACCME’s criteria for CME. ACCME itself will have to revise its Standards for Commercial Support to clarify that in most cases, commercial support is no longer allowed.

None of this will happen overnight, of course. But you can bet that medical societies and medical education companies that are dependent on commercial support are, even as you read this, holding emergency conference calls with their attorneys to figure out what they need to do next.

We have finally entered the era of post-deception medical education. Congratulations to the AMA.

Daniel Carlat is a psychiatrist and author of Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis.

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