OIG-DHHS: Pooled funding for CME

If that alphabet soup is perplexing, folks in the Office of the Inspector General, Department of Health and Human Services, commented on funding for physicians' continuing medical education (see below for cite, subscription required).

Lewis Morris, JD and Julie K. Taitsman, MD, JD include the obligatory Federal disclaimer that they do not speak on behalf of the OIG-DHHS. But they do remind us that their office wields a sizeable stick, having, for example, been involved along with Department of Justice in the recent criminal charges against Pfizer and Warner-Lambert over off-label promotion of Neurontin, which ended in a $430M settlement.

Morris and Taitsman begin by explaining that it is in the public interest to reduce the bias introduced into CME by commercial sponsorship, which now accounts for more than half the total costs of CME in the US. They stress that even if no specific drug is being shilled for at a CME program, commercial sponsorship still skews the content of CME toward drug treatment and the like, and away from equally important topics such as prevention and patient education. They also suggest that current guidelines that supposedly limit commercial interference in the choice of topics and speakers are relatively easy to get around.

They then list several strategies that might be employed to limit undesirable commercial bias in CME programming: avoid commercial funding entirely; insist that companies pay into a common funding pool and then have a neutral third party give CME programs grants from that pool on a competitive basis; accredit specific programs rather than CME providers so that individual programs come under closer scrutiny; and eliminate some types of CME providers who currently receive funding almost solely from commercial sources (medical education and communications companies). The authors' personal choice is for the pooled funding mechanism.

This paper is a good summary of the pitfalls in the current state of CME funding and gives us a hint as to where the Feds are going to be looking for future violations. As we saw in a previous post, others--specifically the IOM--have been less reticent about proposing the full elimination of commercial CME funding as the best option for the future: http://brodyhooked.blogspot.com/2009/05/iom-report-on-coi-yes-we-really-mean-it.html

Morris L, Taitsman JK. The agenda for continuing medical education--limiting industry's influence. New England Journal of Medicine 361:2478-81, December 17, 2009.