Industry Support of CME Declining--Is There a Downside?

An important piece in this week's New England Journal:
http://www.nejm.org/doi/full/10.1056/NEJMp1114776
--by Drs. Michael Steinman, Seth Landefeld, and Robert Baron updates us on current trends in drug industry support for continuing medical education programs.

Major news flash is that industry funding of CME rose to a peak in 2007 but has since been declining. At the height, if you add in all sources of industry support, the drug and related industries paid for more than half the costs of CME in the US. Direct support of CME is now down to 31%.

The authors note, "These changes did not arise from one or two events. Rather, they resulted from shifting norms in the culture of medicine. It is doubtful that all industry involvement with CME will cease in the near future, and the recent decline in industry support may also reflect difficult economic times. However, we appear to be entering a new era in which earlier norms of acceptability no longer apply."

Will the result be a deterioration in the quality of CME? The authors suggest that the reverse is more likely: "Although reducing reliance on industry funds will not be painless, it remains highly feasible to do so in a manner that preserves (and in some ways enhances) access and quality. Costs can be substantially reduced by avoiding high-priced venues such as the hotel conference spaces where CME events are often held. ... Moreover, CME providers are de-emphasizing traditional lecture-hall–based teaching in favor of more interactive, interprofessional, and competency-based learning strategies. Such strategies include online teaching tools, point-of-care CME, and performance-improvement CME, which not only offer pedagogical value but in many cases can also be provided at relatively low cost. This trend is likely to continue as CME is increasingly linked to practice-improvement and maintenance-of-certification processes that require explicit practice-based learning."

Having decided that this trend is here to stay--they reject the hypothesis that shrinking CME support by industry is merely a reaction to the economic downturn--and having opined that on the whole this is a good development, the authors ask if there's any downside. Their biggest concern is the shift in marketing funds away from accredited CME and into activities such as dinner lectures, where the company can totally control the presentation because it need not meet any accreditation standards. The authors suggest that the impact on medicine would be deleterious if docs stopped going to CME sessions and instead went out with the drug reps for steak and wine.

I am less worried about this because there was a reason why the industry, which always had the option of the dinner lecture, nevertheless felt it advisable to shove so much cash in the direction of CME. Pharma knows that docs think differently about a program that grants CME credit and attribute a higher level of authority to such a presentation. Plus the pressures on docs to get a certain number of CME credits per year come from outside industry and have not changed--most physicians need CME to retain licensure and specialty certification. In short, I think that Dr. Steinman and colleagues have correctly assessed the positive about shrinking industry support for CME and have perhaps slightly inflated the negative.