Macy Foundation Report: Industry Reflection?

During the past few months I have contacted people from pharma asking them to do a podcast with me reflecting on what they thought the impact of the Macy Foundation report would have on their sector of the CME enterprise. Several of these people didn’t respond to my efforts to contact them. One indicated the company said not to comment on the report at this time.

During the meeting of the Alliance for CME this past January Mike Saxton, who is with Pfizer, was asked to comment on the report as part of a formal panel. The essence of his comments is provided below. I do not suggest that these comments represent the thinking of the pharmaceutical industry related to the Macy Foundation Chairman’s summary. They are what they are — comments from a person in industry with a long term commitment to the field of CME. We should heed some of what he says.

• The Macy report has many important findings.
• Reflecting on the healthcare crisis in this country we have to guard against letting the issues about commercial support distract us from the more important findings in the report.
• Industry’s role has always been and remains to support the CME profession in its’ effort to improve health care quality.
• If, in the findings of the profession, the conclusion is reached that patients needs are best served by eliminating commercial support then industry will follow that lead. Many in industry are absolutely prepared to do that. Lots of discussion needs to occur around that issue and there is a lot to debate.
• Some of the issues underlying the Macy report are principles that have been governing the field of CME for years. We have not been active enough in creating an action agenda around these issues.
• Balanced funding has been a principle we have all agreed on for some time. Today there is still not an action agenda about what levels of commercial funding are appropriate. He suggests we get on with that work. He also says we do not have to wait for the Macy report or any other group to tell us that we need to collectively, whether that is a drop to zero funding or fifty % or whatever. The profession can start setting standards now. He asserts that commercial supporters would like to see those standards so they don’t independently start adopting different thresholds and different mechanisms to support what the CME profession thinks is in the best interest of patients.
• There remain conflicts of interest issues within the profession that have not yet been addressed are not addressed by the current accreditation requirements. Why wait for Macy or anyone else to tell us that? Create an action agenda that address the issues that matter to patients today, not tomorrow.
• There are a lot of potential industry models for the future ranging form eliminating it to adopting a performance improvement model. Lets’ have that discussion. Let’s not wait for out side groups to engender that discussion on us.
• The Macy report will be a catalyst to have the discussion that we need to have.

Your comments are welcome.

Macy Foundation Chairman’s Report MECC

Representatives of the Alliance for Continuing Medical Education section representing MECCs and NAAMECC chose not to provide me with reflections on the Macy Foundations Chairman’s report. However, there was a document distributed during the January 2008 meeting of the Alliance for Continuing Medical Education by NAAMECC and Coalition for Healthcare Communication. It begins with the following Statement:

We applaud the effort to discuss important CE issues and share the group’s interest in

• providing high quality, unbiased education with the purpose of improving health professional performance and patient health
• To improve the quality of patient care by promoting improved clinical knowledge,
  skills and attitudes and by enhancing practitioner performance
• To ensure the continued competency of clinicians and the effectiveness and safety of patient care
• To provide accountability to the public”

The statement goes on to make the following 15 observations:

• The document is a conference summary from the Chairman’s perspective
• The summary may not fully represent the views of all attendees and their institutions, and it is unclear if the document represents consensus
• The 36 attendees did not represent the full spectrum of CE stakeholders, thus limiting the value of the recommendations and introducing serious opportunity for bias
• The summary includes a series of recommendations that could significantly alter the CE system and infrastructure, the consequences of which are unknown
• The summary recommendations would essentially eliminate commercial support for CE, thereby cutting funding by at least 50% for certified CME alone
• The summary recommendations for CE funding would require significant support from non-traditional sources, including the federal government, which may not be realistic
• The summary recommendations do not appear to be evidence-based, rather they seem to be pre-determined by the agenda and selection of participants
• The summary ignores the fact that all provider types have funding and policy priority challenges
• o The summary fails to recognize the importance of commercial support to improvements in patient care (Agency for Healthcare Research and Quality, February2007)
• The summary misuses standard medical education terminology (e.g., referring to commercial supporters as “sponsors” and incorrect use of the term “accredited”)
• The summary ignores ongoing and increased efforts to ensure independence and decrease bias
• The summary includes no evidence of the Foundation’s or individual participants’ disclosure of personal relationships with industry, conflicts of interest, or attempts to resolve any such conflicts
• The summary ignores basic legal principles of free enterprise and competition and the dangers of monopoly and antitrust (refer to the NAAMECC monograph featuring leading legal experts; see www.naamecc.org)
• The summary recommendations would limit free speech by both providers and supporters
• The summary recommendations would eliminate competition, thereby limiting innovation

For one, I look forward to a more considered response of this segment of the CME enterprise after the publication of the full report.