Tuesday, July 21, 2009

Pharma Pulls Support from CME

Again, I can take a rest while my fellow bloggers do the heavy lifting-- see Danny Carlat's blog:


Danny was right on top of the Accreditation Council for Continuing Medical Education's (ACCME's) 2009 annual report, so he picked up the three key facts that it showed:
  1. Overall CME spending in the US is down from $2.54B in 2007 to $2.36B in 2008, the first year-to-year drop since ACCME was founded.
  2. The reduction is almost completely due to reductions in commercial CME sponsorship, which fell from $1.2B to about $1B.
  3. In turn, this reduction was highly selective among CME sponsors. The medical education and communication companies (MECCs) that are almost solely engaged in for-profit work on behalf of commercial sponsors, had their revenues hit by $131M, or a 22% reduction.
What is going on here? I would propose that this represents a working out of forces that started gathering steam as long ago as 2003. In that year the Office of the Inspector General, Dept. of Health and Human Services (as recounted in HOOKED) issued a report that threatened the drug industry with anti-racketeering legal troubles unless it started to disengage from CME sponsorship that was in any way linked to marketing. The response was immediate, and both drug companies and MECCs started to reconfigure themselves administratively to create "firewalls" between the part of the company that does marketing and the part that does (supposedly) education.

As Dr. Carlat then astutely notes, more recent years have seen further changes. The IOM report came out four-square for a serious divestment by Pharma from CME programs: http://brodyhooked.blogspot.com/2009/05/iom-report-on-coi-yes-we-really-mean-it.html The American Psychiatry Association has announced its intention to end all programs sponsored by MECCs at its annual meeting. The AMA's Council on Ethical and Judicial Affairs took a serious swipe at MECC-run CME programs in its draft report on physician conflict of interest. One could say that the handwriting was on the wall that this activity was due for increased regulatory scrutiny and ethical condemnation. The industry may have decided to cut its losses.

Does this mean that the MECCs will go belly-up? Not necessarily. So far as I have been able to learn, an MECC can function in two different ways. It can administer CME courses for which credit is given to physicians in accord with the ACCME rules. Alternatively, it can plan and conduct "educational" programs on behalf of commercial sponsors for which no CME credits are awarded. In the latter case, the rules can be just about as loose as you want, and the meeting can be frankly a marketing session. The new code of conduct from PhRMA suggests that the industry is not about to give up its policy of handing out free meals to docs in exchange for their getting "educated." So it remains to be seen if the drug industry has pulled $200M annually out of physician "education" across the board, or whether it has shifted that money into less regulated, non-CME-credit-granting activities over free dinners. If any readers have any insights into that please comment.

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