Friday, July 31, 2009

Ban Industry-Funded CME--and the ACCME, While You're at It

I'm indebted both to the Prescription Project and to Danny Carlat's blog for accounts of the hearings of Sen. Herb Kohl's (D-WI) select committee on aging, on the issue of industry funded CME and sunshine legislation.

The decks were somewhat stacked with those opposing industry funding. The redoubtable Dr. Thomas Stossel of Harvard and ACRE (see previous posts too numerous to list) was on hand to offer the non sequitur, that because scientific advances in medicine over the past 40 years had helped people, and for the past 40 years we have permitted industry funding of CME, we need to continue the latter or we risk losing the former. Al Franken, making his Senate debut following his long-disputed election in MN, offered the comment that he did not see any logic in Stossel's reasoning. I suppose Franken, as a former comedy writer, is especially qualified to understand the reasonings of Dr. Stossel and colleagues. (Sorry, couldn't resist that.)

All that is bye the bye, as I think the most important exchange by far at the hearings was the indirect exchange between Dr. Steve Nissen of Cleveland Clinic, and Murray Kopelow, head of the Accreditation Council for Continuing Medical Education (ACCME), the outfit that is supposed to monitor all US CME activity. Kopelow offered what to our commentators appeared to be pretty wimpy testimony. Prescription Project summarized it as: "[A]fter mulling a stop to accredited industry-supported programs in 2008, the [ACCME] 'would not be taking any action to end the commercial support of accredited [CME],' and defended its continued efforts to clarify independence criteria and firewalls." The basic message appeared to be: trust us, we're taking care of everything, just leave it to us.

By contrast, Steve Nissen came out swinging. Again, per Prescription Project, Nissen "called the [ACCME] 'uninterested or incapable' of enforcing its own rules, and called for its end. 'Whatever ACCME is doing is ineffective,' said Dr. Nissen. 'We need ACCME to go away and we need to replace it with something else.' He said that third-party companies called medical education communication companies are very much behind the wheel of CME programs that claim support from 'unrestricted educational grants,' and that based on the selected topics and speakers, he can nearly always guess the sponsoring company." To which Danny Carlat added the anecdote that he knows that at least on some occasions, ACCME slaps the wrist of a CME sponsor that allows undue commercial bias, because they issued such a letter after he once complained. Only ACCME took two years to do it, and Danny cannot tell us any details because ACCME also put a gag order on him.

Now, if you go back and look at some of my earlier posts on this blog as well as in HOOKED, I think in hindsight I was overly deferential to ACCME and took them more at their word, that they were working diligently to create firewalls and police commercial bias, than should have been the case. I have certainly heard comments from CME coordinators to the effect that what the CME rules are supposed to be, and how people behave in real life, are often two different things.

Danny Carlat, who blogged the hearings live, also offered later reflections as follows (

Senator Mel Martinez, a republican from Florida, summed up the mood best with his perplexed question (I'm paraphrasing here): "Wouldn't it just be better if doctors paid for their own continuing medical education?" As a lawyer, he said, he always paid for his own CLE (continuing legal education) and he was never paid to give CLE lectures.To those of us who have lived and breathed this issue for years, his question came across as innocent, but in fact it hit the obvious point, and surely summarized the view of most Americans.

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