We at Public Citizen were pleased to hear that the Accreditation Council for Continuing Medical Education’s (ACCME’s) Proposed Policy to Support Independence in Accredited Continuing Medical Education (CME) gave at least passing consideration to a proposal that “the commercial support of continuing medical education [should] end.” While we know this is a long-shot, we felt compelled to weigh in. That’s how activists get their jollies after all.
Call us pedantic if you like, but we just don’t think that for-profit companies, like drug makers, should be footing the bill for doctors’ continuing education. Ultimately, what your doctor learns will affect the care you receive. We simply can’t compromise on the integrity of anything likely to affect clinical care, and that’s exactly what this issue comes down to at the end of the day.
Here’s the deal: Since the 1970s, in order to be allowed to practice in most states, doctors have been required to take a certain number of CME courses per year. It’s a system designed to ensure that you, the patient, always receive up-to-date care.
Hey, we’re for that.
But the CME sessions inevitably cost money. And when the courses became a requirement for state licensure, commercial interests (primarily drug companies) were happy to pick up the tab; in 2007, 47% of CME funding (over $1.2 billion) was provided by drug companies, device makers, and other commercial interests.
But wait. Doctors are going to have to take the classes no matter who pays for them – if they don’t, they can’t practice! Well, doctors, wanting to keep the costs as low as possible for themselves, allowed pharmaceutical companies – no fools when it comes to exploiting golden opportunities – to fill the breach.
Why would pharmaceutical companies want to be so generous toward doctors? By paying for the classes, commercial interests get a say in the agenda. And because of that (surprise, surprise), the topics addressed are typically those for which a product (usually a drug) exists – and this means that topics about public health or lifestyle and behavioral interventions may not get the attention they deserve. In a number of instances, drug companies have even had input into the actual content of the lectures.
Thus, apparently altruistic commercial support can rapidly mutate into preferential emphasis on the sponsor’s drug. That means that when your doctor learns about “advances” in treating high cholesterol, he or she may be hearing about it from the perspective of a company that happens to manufacture some shiny, new drug for lowering cholesterol. We’re not saying that doctors shouldn’t learn about the shiny, new drug, just that they should learn about it in an objective way (and they should also learn about less-shiny drugs that are likely to be less expensive and may be just as effective).
While some may argue that it is too extreme to go cold turkey and end commercial support of CME, we believe that, with a few changes, industry-free CME is within reach. For one, the profit margin of this educational industry (oxymoron, we know) has exploded; overall, the CME industry clears an impressive 23% profit margin! (We bet Lehman Brothers would settle for that.) It was only 5% ten years ago. Moreover, we think doctors, who occupy the highest echelons of the payment pyramid, could stand to contribute a bit more for CME; after all, it is their education. Lastly, we don’t think that these meetings need to take place in the Bahamas, Maui or some other pricey hot spot and they certainly don’t need to be as fancy as they are (if you’ve ever been to one, you know what we mean). If doctors were paying the bill, they would be much more likely to compromise on the perks that are now paid for by drug companies (and thus, patients, in the form of higher cost for drugs).
Therefore, we think commercial interests should be eliminated from CME – it’s the best way to eliminate conflicts-of-interest and maintain the educational integrity of CME. Most importantly, kicking commercial interests out of the CME business is good for patients.
You can read our comments here.
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