One problem I continually run into as an academic-type physician is to get a fix on what's happening out there in the "real world." We've seen on this blog recently how if one only looks from the vantage point of the ivory tower, it would seem as if pressure is mounting to free continuing medical education from commercial influence. Authoritative groups such as the Institute of Medicine have called for a complete rift betwen CME and industry funding:
http://brodyhooked.blogspot.com/2009/05/iom-report-on-coi-yes-we-really-mean-it.html
The real-world perspective was brought to my attention today by some colleagues who have been pioneers in creating CME venues that support themselves completely with registration fees and accept no industry cash. Names will be changed to protect the guilty, so let's just say we are going to talk about a certain state-level medical specialty society in an unnamed state.
My friends had entered into some discussion with that state society to see about offering their CME program in connection with a society meeting. There was some hemming and hawing--amidst profuse expressions of approval for the excellent way that the CME program had been organized and its superb content. When they asked folks to please fish or cut bait, they were able to get the following statement from a Deputy Executive Vice President of the organization: "I can't say 100% no, but I seriously doubt we can use this format for our annual meeting. We use our meeting to launch many of our national initiatives, and they all have commercial support. If we were to use this format/meeting, it would have to be at a different time of year, and I do not think that's an option for us right now. Will chat with X about this...but don't get [your] hopes up."
Reading just a bit between the lines, somebody else involved in the negotiations translated the above as: "They won't offer a good course with proven reviews because they risk offending their commercial support?"
So from one vantage point we seem to be making real progress. From another vantage point, not only can we not get rid of commercial report for CME and other medical organization "initiatives," but we cannot even offer a commercial-free CME program at the same time as the meeting where the commercial folks show up, lest the commercial people take offense.
All of this led one of the parties to this discussion to conclude: "I don't know how we ended up in such a sleazy business."
Deja Vu All Over Again Department: Did you think you heard this story somewhere before? Well, you did. A few years ago, as I described in HOOKED, Dr. Bob Goodman tried to purchase display space in the annual meeting exhibit halls of both the American Academy of Family Physicians and the American College of Physicians, to set up a table for his "No Free Lunch" campaign and distribute buttons. Both groups initially refused to allow him into their exhibit halls, obviously out of fear that he'd offend the really well-paying customers.
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I think the old saying is true, "money corrupts". Our hospital has Wednesday Grand CME Rounds for physicians, et al. They are always good talks and sponsored by Pfizer, BI or somebody else. But I can't say there is an obvious conflict of interest as the speakers are supposed to reveal any endorsement deals up front. I have also heard physicians tout methods/products that were contrary to the sponsor, which I thought lent credibility to our program. For instance when Spiriva first hit the market, the pulmonary physicians presented an update on COPD mgt. and were very careful not to overstate the possible benefits of Spiriva. The MD's were very understated, even skeptical, in their explanation of Spiriva and the scientific data, despite Pfizer sponsoring the Grand Round.
But I can see where inpropriety could still be hinted at, so separating the money from the education seems like a great idea. But this means either physicians will have to take less honorariums or somebody else will have to pick up the tab.
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