Backers Warn of Major Fallout if Industry CME Funds Banned

Although industry-funded continuing medical education (CME) has been much maligned by medical journals, professional organizations, and legislators recently, some advocates and prominent physicians believe that banning industry funding would do more harm than good.

Currently, pharmaceutical and medical-device companies fund half of the $3 billion CME industry, and much of this money goes to for-profit medical communication companies that organize CME programs and symposia (Psychiatric News, April 4, April 18). This aspect of the industry-medicine relationship is just one of many that has been criticized for potential or existing conflicts of interests by voices outside and within the medical profession, including Sen. Charles Grassley (R-Iowa), chair of the Senate Special Committee on Aging, consumer-advocate groups, and some academic physicians (Psychiatric News, August 15).

The AMA's Council on Ethical and Judicial Affairs, for example, proposed eliminating all industry funding for professional education activities earlier this year. Similarly, the Accreditation Council for Continuing Medical Education (ACCME) recently invited public comments on a proposed ban of industry funding for CME.

At a public meeting last month in Washington D.C., organized by the nonprofit Center for Medicine in the Public Interest (CMPI), several notable physicians and representatives of for-profit medical communication companies strongly opposed the view that industry funding for CME is harmful to the medical profession.

“The system works,” said George Lundberg, M.D., editor-in-chief of Medscape Journal and the eMedicine Web site. Medscape provides online CME funded by pharmaceutical companies, with free access for health care professionals. The current guideline for conflict-of-interest disclosure by the ACCME is sufficient to prevent CME authors from presenting biased information, he stated.

Lundberg was editor of the Journal of American Medical Association (JAMA) from 1982 to 1999. He noted that the AMA cannot be entirely free of ties with industry; for example, it was JAMA advertising revenue that allowed AMA to charge no membership dues until 1948. Some academics “simply feel ideologically that physicians have to pay for their CME,” he reflected. “We all have conflicts of interest, overt or covert.”

Lundberg disagreed with recent commentaries in JAMA on conflict-of-interest issues. Arnold Relman, M.D., editor-in-chief emeritus of the New England Journal of Medicine and a professor emeritus of medicine and social medicine at Harvard Medical School, wrote in the September 3 issue that “the responsibility for medical education should be entirely in the hands of the medical profession, and funding should not compromise, or even call into question, the integrity and independence of what is taught.”

Other physicians who spoke at the meeting agreed with Lundberg's sentiment. “Banning industry-funded CME is not justified and will have unintended consequences, especially in primary care and psychiatry,” said Roger Meyer, M.D., a clinical professor of psychiatry at Georgetown University Medical School and president of the American College of Neuropsychopharmacology in 1993. He is also a partner at Best Practice Project Management Inc., a consulting company that works with drug companies.

Meyer pointed out that in academic medical centers, the departments of primary care and psychiatry do not generate enough profit for themselves to sustain the training necessary for residents and students, and centralized institution-generated CME programs often cost the departments. Without industry funding, these departments cannot afford to bring in distinguished outside experts for their grand rounds.

Recently Pfizer became the first drug company to halt direct funding to for-profit medical communication companies (Psychiatric News, August 1). Representatives from the CME industry, including Marissa Seligman, Pharm.D., senior vice president of Pri-Med Institute, a large medical communication company, reported at the meeting that industry funding for CME has declined noticeably in recent months. The for-profit CME industry has maintained that industry funding allows more effective, innovative, and widely accessible educational programs, particularly for those with no academic medical center affiliations or those with primary care practices in underserved areas.

If industry funding dries up, either because of regulation or industry's business decisions, physicians also will lose many of the educational services provided by professional associations, suggested Jack Lewin, M.D., chief executive officer of the American College of Cardiology (ACC). Without industry grants, the ACC would have to charge $2,000 to $3,000 registration fees per attendee to maintain the same educational content and services currently provided at annual meetings, he estimated.

If all industry support was banned, the ACC would certainly have to cut member services or charge far higher member dues, Lewin told Psychiatric News. By pooling industry funds, building a “firewall” between the sponsors and CME content development, and scrutinizing potential conflicts of interest of authors and faculties, CME can be free of bias.

“Transparency is beneficial,” he said. “[Banning industry support] will slow the dissemination of knowledge.”

Robert Goldberg, Ph.D., vice president and cofounder of CMPI, told Psychiatric News that the organization receives donations primarily from pharmaceutical and biotechnology companies. Peter Pitts, president and cofounder of CMPI, served as the associate commissioner for external relations at the FDA from 2002 to 2004.

The meeting was cohosted by the Coalition for Healthcare Communication, whose members are medical publishing, advertising, and marketing organizations. ▪