Getting Around Disclosure of Funding – Not the Way to Go

Click here to read an interesting article that appeared recently in the New York Times. Note the concern expressed by Murray Kopelow on page two in the last few paragraphs of the article.

I guess money talks regardless of the source.

Mass Law on Gifts to Physicans Goes Beyond Reason?

In a blog on “Policy and Medicine” you’ll find an interesting post on the impact of a proposed law in Massachusetts related to gifts to physicians.

You might find this very interesting and somewhat concerning.

AAMC Report on Industry Support of Medical Education

The AAMC recently released a Task Force report on Industry Funding for Medical Education. The report, scheduled for consideration in June, includes several recommendations related to continuing medical education. The deliberations of this group could impact your CME program.

B. Content Validation of Continuing Medical Education

Principles that should guide academic involvement in CME include the following:

· The content of CME presentations must be science-based and unbiased, and the content must be determined independently from the source of commercial support.²⁷

· As is required by the ACCME, academic medical institutions should monitor the content of CME they sponsor as part of the ongoing effort to ensure the quality and objectivity of education provided to physicians, students, and trainees.²⁸

· Academic medical institutions can receive commercial support for evidence based CME they provide to assist physicians in maintaining competency during their professional careers, to help to address the “knowledge translation block,”²⁹ and to improve the quality of care.

Academic medical centers are already accountable to ACCME for verifying that CME course content is fair, balanced, and independent of commercial influence, but additional methods of content validation need to be developed—such as external auditing—that are effective, efficient, and realistic. It is important to recognize that assuring that course content is evidence-based is challenging and requires flexible systems that can accommodate emerging science and differing medical perspectives.

Notes

27. The ACCME standard indicates that “CME providers cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.”

28. The ACCME standard indicates that “Accredited providers are responsible for validating the clinical content of CME activities that they provide.

Specifically: 1. All the recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. 2. All scientific research referred to, reported or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis.”

29. The phrase “knowledge translation block” refers to the barriers involved in moving the results of medical research and clinical trials that identify good practice into widespread use in medical practice.

Recommendations:

• The AAMC should collaborate with ACCME to create a process by which CME offerings would be externally spot-reviewed or audited for consistency with applicable guidelines and for the presence of inappropriate influence.

• Such a process could be designed to sample appropriately a wide range of offerings on a national basis and provide expert review of them, perhaps through an expert review committee. An expert panel could be appropriately supplemented with content-area expertise to address CME offerings in areas with significant potential for bias, for example, 8 to 10 high-impact, new therapeutic areas where accessible post-marketing information is scant. Questions to be considered include whether national, regional, or local panels would be appropriate for this effort, how they would be funded, and what roles medical schools and teaching hospitals might most appropriately and realistically play.

• The AAMC should participate with key national medical organizations, such as the American Medical Association (AMA), the ACCME, the Society for Academic Continuing Medical Education (SACME), and other professional societies in an initiative to define the processes and structure that would best be able to ensure the provision of sound, timely, scientifically objective CME that meets the educational needs of physicians.

Through this partnership, academic medicine could contribute to the development of new ways to exchange information with their practice communities and to provide CME that is evidence-based, scientifically rigorous, free from bias, and meets ACCME requirements. Since the ultimate goal of CME is to facilitate change at the point-of-care, the structure should leverage new technologies, including health care information technology and Web portals, to provide enhanced levels of learning that will

Since I am not involved in medical school CME I am not going to comment on the report. I am concerned about the effect that the cumulative effect on the increasing number of suggestions related to CME will soon have an impact that many in the CME enterprise wil not be happy with.

What do you think?