Posts filed under ‘Pharma Funding’

Revisit…….Why Fund CME?

NOTE: I have published this blog before but had the urge to do it again when I heard this.  In a side conversation at the recent meeting of the National Task Force on CME/Provider/Industry Collaboration someone said that an employee in one of the grants offices in industry was told by the higher ups that they were not sure the company was going to continue supporting independent CME. One of the reasons was a reaction to the recent CEJA  report calling for “limitations” on corporate support for CME. So here is what I mused before.

Suppose I own a pharmaceutical or medical device manufacturing company. You know what? I am going to shed providing support for accredited CME and I am doing it right now. My company does not need the extra hassles.

Please understand. I see how my company’s support for CME adds value to the relationships we have with our customers. And, in my opinion, this support is not as “evil” as some in organized medicine are making it out to be. But you know what? There are too many in the CME enterprise, the physician community, and government questioning that any value can come from my business supporting CME. Do you think I need that kind of press? What about the exposure coming from the federal government? And I really don’t need a bunch (although a minority) of boisterous customers and organizations that supposedly represent my customers shouting to the world that my company should not be supporting their CME. Nope. No thanks. Nada.

I don’t need the extra costs of staffing the CME function in my company. Grant applications. Grant application reviews. Compliance officers. Compliance reviews. LOA’s. Check requests and disbursements. Project reconciliation processes.   Why pay the overhead to house these functions. I don’t need the costs of educating my employees about the CME rules and regulations. I have to pay a lot to monitor employee performance to be sure they don’t get my company in trouble by breaking some inconsequential CME rule or regulation. I really don’t like the entitlement attitude some physicians and physician organizations have that suggests my company owes it to them to support their pet CME project because they use my company’s products. On and on.

I don’t need the hassles and intimidation the federal regulators put on my company to insure compliance with their requirements. Who wants to be looking over your shoulder all of the time for fear the feds will come calling.

I don’t want to wonder if the money my company puts into the CME enterprise is having an impact on health care delivery. I don’t want to have to wonder if the money I put into CME is having and impact on patient health status. You know what? If my company puts money into the CME enterprise my shareholders want to know what impact the money is having on the delivery of evidence based patient care and to the extent possible patient health status in clinical areas of interest to my company. And yes, my stockholders want to know if the investment in CME is having a positive impact or any added value for our customers and the company – bottom line included but not exclusively.

Am I going to put the money I have been allocating to support CME into a big ole pot and let someone outside of my company decide how to spend that money with no accountability back to my shareholders? Are you crazy?

People in my company can’t even talk to CME providers about areas of mutual interest. Like I am going to give money to someone my company representatives can’t even engage in a significant and appropriate dialogue. Right!

So what about the notion that the money my company puts into CME impacts the cost of drugs and thus the cost to the patient. Of course it does. My company is not a charity. I have to recoup those costs. Removing my support for CME will not reduce those costs. If health care providers have to bear the costs of their own CME who is ultimately going to pay? The patient of course. Health care costs might actually go up when I  take what I have been spending to support CME and spend it on something that will add value to my relationships with my customers. And I assure you I will find a way to do that.

And by the way the CME enterprise will save money when we stop funding CME. No need for the AMA to spend money on the annual Task Force meeting. ACCME can cut the accreditation application and review process in half by eliminating all of the questions and documentation required related to commercial support for CME. Wow. CME providers might be able to say they are part of the “Green Movement” with all of the paper saved. The Alliance can reduce the number of days needed for its annual meeting saving its members travel and lodging costs to attend the meeting. The CME enterprise won’t need the new “Faculty Development” initiative to teach physicians who speak at CME events the difference between CME and marketing (oh please).  CME providers can save money on going to all of the meetings they think they can’t miss because they need to get the latest information on how to effectively beg for bucks. CME providers won’t have to spend all of that time writing grants chasing support. Our sector won’t have to spend the money on all of the high cost conferences that try to address the maze of rules and regulations imposed on our support to the CME enterprise.  Wow. What a savings for everybody. Everybody except the physician and patient of course. Physicians will still have to engage in CME and to pay for that CME. Physicians will pass those costs on to their patients.

What will happen in the CME field when money from the pharmaceutical and device sector is gone? The requirements of physician participation in CME are not going away. In fact, those requirements are becoming more rigorous and narrowly focused. Look at maintenance of certification requirements and the  proposed rules for maintenance of licensure.

Pharmaceutical and device companies still have the obligation of educating those who purchase and use their products. They must continue to support education of physicians. This will be a bit easier in the absence of the accredited CME hassles.

Every system is perfectly designed to get the results it gets. If the CME system is not getting the results it wants then that system has to change. Pharma and device manufacturers support for CME can and probably will be stopped. The CME system will change as a result of that decision. Will that be the magic bullet that will enable CME to reach its full potential in impacting patient outcomes? Forgive me. I am a skeptic and I approve this question.

Tell me again why pharma and device manufacturers should support accredited CME? I seem to have lost my interest in doing so.


September 28, 2011 at 11:38 pm Leave a comment

Pharma Tightens Screening of Physicians They Pay

Drug Firms Say They’ll Take Closer Look at the Docs They Pay
ProPublica Nov. 18, 2010

“Several of the nation’s largest pharmaceutical companies said they plan to tighten screening of physicians who promote their drugs after ProPublica reported last month that more than 250 of them had been sanctioned for misconduct……………”

….”Seven drug companies paid $7.1 million to 292 doctors who faced disciplinary action or other regulatory sanctions, ProPublica found. Several companies say they may take steps to tighten screening procedures for physicians who are paid as speakers or for other activities promoting prescription drugs…….”

NOTE: This has compiled data from seven companies, covering almost $282 million in payouts since 2009 for speaking, consulting and other duties. You can search the database to see if physicians you use in your CME activities have received payments from the companies in the data base.

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November 18, 2010 at 7:24 pm Leave a comment

CME in the News and on the Blogs – November 9, 2010

NOTE: This story isn’t directly related to CME but addresses a topic on all of our agendas.

Doctor-industry Relations Down, but Still Strong
DOTmed NewsNovember 08, 2010

“Increasing media scrutiny, congressional investigations and a down economy have taken their toll on doctor-industry relationships, but they remain strong, according to the results of a new survey

A report published Tuesday in the Archives of Internal Medicine said the number of doctors receiving drug samples, food and drinks, paid trips for meetings or continuing medical education events, speaking fees and other forms of compensation dropped 12 percent between 2004 and 2009. Nonetheless, nearly 84 percent of doctors admitted some kind of physician-industry relationship, or PIR…………”

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November 9, 2010 at 7:41 pm Leave a comment

Has commercial support for CME bottomed out?

Here is a prognostication all of you dependent on commercial support for your CME activities will want to read. What does your crystal ball say?

Medical Marketing & Media
By Marc Iskowitz
October 13, 2010

“Industry support for continuing medical education (CME) has been waning the last two years, but some say the bottom may be in sight………………

……..And the CME profession is nearing consensus on the funding issue. A national recommendation is due out in draft form early next year from the Conjoint Committee on CME (CCCME). In addition to its 16 member organizations, another eight were invited to an August meeting. The CCCME, formed in 2009 at the behest of the Institute of Medicine (IOM), is unlikely to declare commercial support problematic, said Dr. Norman Kahn Jr., convener of the group. A March 17 summit is planned for Chicago with the draft report due out this January.

Explaining what the committee found when it delved into the evidence, Kahn said the data are “incontrovertible” that direct financial payments to faculty lead to influence, but a commercially supported CME activity whose faculty have no such ties most likely does not lead to bias. “[W]ithin the context of the firewalls created by the ACCME’s Standards for Commercial Support, it’s the opinion of the profession that if you follow this framework, you can eliminate influence from commercial support.” Specifics on how to manage conflicts will find their way into the committee’s report, he said………”

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October 14, 2010 at 7:54 pm Leave a comment

Some Docs Believe they Deserve Dinners and Gifts

You’ve got to be kidding me. An entitlement attitude before they ever finish residency training. Does it get any better when they enter practice? I wonder.

Pharmalot: by Ed Silverman September 15th, 2010

Among the many contentious debates embroiling the pharmaceutical industry in recent years is the argument that freebies given to doctors – gifts, meals, dinners and trips – unduly influence the physican mindset. But why do some docs believe accepting such goodies is okay? A new study offers a clue – some docs believe these treats are a reward for the sacrifices made to study medicine.

Two Carnegie Mellon University researchers asked 301 pediatric and family medicine residents about the appropriateness of accepting freebies. But they were divided into three groups. Before completing the survey, one group was asked about sacrifices made in getting their education. Another group was asked the same questions but also whether the sacrifices – poor working conditions and school debt – justified accepting gifts. The last group was asked about accepting gifts but without first being asked about personal sacrifices or justifications that may have allowed them to rationalize.

The upshot? First reminding docs of the effort to obtain their medical education more than doubled their willingness to accept gifts – from 21.7 percent to 47.5 percent – and suggesting the potential rationalization further increased their willingness to take a freebie – to 60.3 percent (here is the abstract).

The finding “suggests that even justifications that people don’t accept at a conscious level can nonetheless help them to rationalize behavior that they otherwise might find unacceptable,” Sunita Sah, the study’s lead author and a former practicing doc who consulted for drugmakers, says in a statement. “Given the powerful human capacity to rationalize what benefits us, it is unlikely that we will be able to make a dent in the problem by, for example, educating physicians about the risks posed by conflicts.”

Her co-author, George Loewenstein, was even more succinct: “In other areas of life, bribes are a crime,” he tells The Pittsburgh Post-Gazette. “The obvious policy response is eliminating the ability of pharmaceutical companies to pay physicians to prescribe their drugs.”

September 15, 2010 at 10:58 pm Leave a comment

CME Professionals Have Performance Gaps Too

From time-to-time I am asked to review grant request seeking support for CME activities. Recently I had the opportunity to review a nine requests seeking support for CME activities in a specific therapeutic area. Applicants could apply for the grants through one of the myriad of online grant application systems we all have come to either love or hate. This particular system asked applicants a series of questions that provides the granting agency information that would be required to meet ACCME accreditation and AMA CME credit requirements.

After asking the applicants the title and proposed target audience for the project they were asked two questions:

  • What is the professional practice gap your project will address?
  • How do you know that your target audience has this professional practice gap?

With the exception of one applicant, the answers showed a definite lack of understanding of what comprises professional practice gaps. The most common response to the questions referred to the prevalence of the medical condition of concern in the patient population in their service area. Not one word was said about the capabilities or lack of capabilities of the target audience in screening, diagnosing, or treating the medical condition. These applicants completely missed the boat regarding what constitutes a professional practice gap. Remember, these applicants are CME “professionals” working in accredited CME provider organizations. These CME providers demonstrate a clear professional practice gap of their own.

The groups providing funding for CME initiatives know the CME requirements imposed on CME providers. They expect CME providers to demonstrate an understanding of these requirements. When we submit funding requests demonstrating a clear lack of understanding of the most basic requirements in our enterprise it is no wonder these projects are summarily rejected. We need to get our individual and collective acts together. We are demonstrating our deficiencies every time we submit proposals that show we don’t get it.

CME professionals must be able to demonstrate a working understanding of what is required of accredited CME providers to offer approved CME activities. For example, as demonstrated in the proposals I reviewed, if we don’t even know what constitutes professional practice gaps and how to measure them we have a huge performance gap of our own. (By the way there were other things that these folks demonstrated they didn’t understand) These gaps absolutely must be addressed. Current CME staff not possessing the basic skill set to operate a CME program in compliance with ACCME expectations need to get the skill sets or get out of the business. There are lots of resources to help us acquire and develop these skills. Use them or we need to lose you.

August 16, 2010 at 5:46 pm Leave a comment

Here is a Story about Collaboration that Defies the Pharma Bashers

Rare Sharing of Data Leads to Progress on Alzheimer’s
New York Times, August 12, 2010

In 2003, a group of scientists and executives from the National Institutes of Health, the Food and Drug Administration, the drug and medical-imaging industries, universities and nonprofit groups joined in a project that experts say had no precedent: a collaborative effort to find the biological markers that show the progression of Alzheimer’s disease in the human brain.

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August 13, 2010 at 5:48 pm Leave a comment

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