Saturday, June 25, 2011

Lightning Strikes: AMA Adopts Strong Statement on Commercial CME

According to our friend Dr. Danny Carlat (as passed along by PostScript):
--an unprecedented event occurred on June 20 in Chicago at the meeting of the AMA's House of Delegates. A bit of background to explain this (unfortunately, background not fully provided in previous blog posts here).

For a number of years the Council on Ethical and Judicial Affairs (CEJA) at the AMA has been proposing new opinions on the ethics of the relationship between physicians and the drug industry, along the lines of the reforms advocated in this blog. The existing AMA opinion on the topic is, in my own view, quite wimpy and offers all sorts of loopholes to excuse docs taking bennies from the drug industry. You can read it here:
That opinion dates from 1992. Several times in recent years, CEJA has offered revised and updated opinions that come down more strictly on policing the conflict of interest inherent in docs accepting gifts/bribes from Pharma. Each time the report was sent to the House of Delegates, and each time the HOD slapped it down and sent it back to CEJA for rewriting. This is a perennial problem in the AMA--in this sense the HOD is too democratic. It seems that if CEJA tries to say something is ethically improper, and if any significant number of Delegates currently do it, the question shifts from the reasonableness of the ethical principle to "how dare my AMA tell me that I'm unethical!" So it can become an ethical race to the bottom instead of aspiring to higher levels of professionalism. (PS: Since the AMA seems to employ a webcrawler to alert them to any mention of their organization on the Internet, you can expect a comment to appear below from the AMA president, in about 3.6 seconds, informing us that what I just said is unfair and not representative of the AMA's good works. For previous comment like that see:

In a similar vein, CEJA proposed back in 2009 a report specifically on commercial sponsorship of continuing medical education programs:
--which the HOD rejected, presumably on a matter of technical language. But some inferred from the HOD action that really, the organization was not all that interested in ending the commercial sponsorship gravy train, that currently keeps many state medical society meetings (for example) afloat financially.

So when CEJA came back with a revised CME report, this time really strict on cutting the financial ties with industry, I would have guessed it would get the same frosty reception from tghe HOD. To my surprise Dr. Carlat tells us that the new report actually passed and has become official AMA policy. Not only that, but because of the relationship betweeen the AMA and the Accredition Council for Continuing Medical Education, the national group that certifies CME programs for official credit-granting status, this change immediately impacts ACCME policy as well. The CEJA opinion (see link on Dr. Carlat's blog) cites particularly the recent Institute of Medicine report on conflicts of interest that similarly proposed elimination of commercial funding for CME, as we reviewed:

Dr. Carlat adds some notes of caution, in that the report does allow for some commercial sponsorship to continue. The exceptional case they seem to contemplate is when a new medical device is introduced, which is very expensive, and the only people who really know how to train docs in its use are the employees and consultants of the company that manufactured it. They give a number of reasonable precautions to keep commercial sponsorship limited to these unusual types of situations, and also to further mitigate the biasing effects of that sponsorship even when it is allowed. In short, I think Danny Carlat is right to call this a very significant breakthrough from an unexpected quarter.

No comments: