Just to prove me hopelessly behind the times, no sooner do I get around to posting about the LA Times editorial bemoaning the delayed release of Federal regulations to implement the sunshine provisions of the Affordable Care Act (see immediately previous post) than I hear from my esteemed bioethics colleague Dr. Alice Dreger at Northwestern about a post at Forbes:
--in which medical journalist Larry Huston reports that the regs are finally out, but that they contain a notable gap for continuing medical education programs.
Let's look at both sides of the controversy Huston hints at. In support of the decision made by the Feds, a CME program that follows the appropriate guidelines from their accrediting body (the ACCME) is supposed to assure that the committee that selects speakers functions independently of any fund donor. So if the good Dr. Kol is chosen to be a CME speaker at a particular conference, and if Carter's Little Liver Pills paid money to support the conference, then Carter's giving money should have in no way influenced the decision to pick Dr. Kol. It would therefore be highly inappropriate to have Dr. Kol listed, on the public website identifying drug company payments to docs, as being in the pay of Carter's.
What about the opposing argument? As Huston points out, it's not as if either the CME planners or the drug firms are dolts. The drug companies support CME programs out of their marketing budget, as a rule--not out of some charity fund. (duh.) If they use marketing $$ for this purpose, it means the company sees some sort of ROI, which to us non-MBA types is "return on investment." If they plow bucks into CME, it is supposed to pay off in increased revenue from drug prescriptions.
Now, what if they give money to a CME program and they don't see the sorts of ROI they were counting on? Do you think they'll be as eager to give money for the next CME program those planners propose? Of course not, and the company knows this and the CME planners know this. That's "independence" for you.
So is it fair that Dr. Kol ends up on the "sunshine" web site personally named as having taken company cash? Well, if he is, then maybe CME speakers will be happy to have their true role in this shell game called by its right name. If not, then the Dr. Kols of the world can start letting CME planners know that they need to run their programs without commercial sponsorship--as the American Psychiatric Association, for one, has already recommended:
--and as the Institute of Medicine report on industry influence also has called for: