“The problem is not that there isn't enough drug company money available for CME. The problem is that there's so much that it's distorting the entire system.” That was the pro-vocative comment made by Richard Van Harrison, PhD, CME director at the University of Michigan Medical School, when we interviewed him for an article on alternative sources for CME (see page 22). Intrigued, we asked Harrison, who also is a member of the National Task Force on CME Provider/Industry Collaboration, and the Working Group on Communication about Ethical Gifts to Physicians from Industry, to expand on his comment.
Q: According to the most recent figures available from the Accreditation Council for CME, a little more than half of nationally accredited CME providers' total CME income — more than a half-billion dollars — comes from commercial support, advertising, and exhibits. What would happen if the pharma portion of that money suddenly disappeared?
A: A lot would change! If all the drug company money were wiped out tomorrow, CME providers would have to base their activities on what physicians felt was worth their time and money. There would be a lot fewer courses, physicians would have to pay a lot more for them, and the education would be really attuned to what physicians want to learn. Now education activities are only partially attuned.
Q: Why is that?
A: Because true “end purchaser” economics only partially apply in current CME financing. Because drug companydepartments are only interested in supporting topics related to their drug area, CME curricula are distorted toward those areas. I'm not saying the content of specific presentations is biased, just that what's available is distorted compared to what physicians need to learn to better their practices and their bottom lines. Some financial help is appreciated in getting the word out about a new type of treatment that physicians are not aware of. But overkill quickly happens when several companies have new competing drugs. Some recent examples are new SSRIs for treating depression and new lipid-lowering drugs. Sometimes it seems as if all of the companies are paying for the same CME course to be put on in local hotels every Saturday morning for months.
The whole “business” side of CME has shifted. Last year medical schools typically offered 40 percent more CME programs for physicians in their communities than they did six years ago, largely paid for by a 60 percent increase in funding from commercial companies. The number of physicians hasn't increased anywhere near 40 percent, and physicians are under increasing time pressures that won't let them go to more CME activities. You offer more courses with somewhat lower numbers of participants per course. You become more dependent on commercial support to make the financial difference. When you see so much CME dependent on it, you have to wonder if it's an addiction.
Huge conflicts and distortions come with money in these amounts. You have to take a look at the larger economic reality of the situation. You have to manage the inherent conflicts of interest that arise when the primary motivation of the companies paying for more than 50 percent of nationally accredited CME is increasing their bottom line. And you have to look at your own motivations when you accept that much money from them.
Q: How do CME providers balance the need for commercial support with providing unbiased education?
A: We have to develop new perspectives on what is occurring. We have been thinking on a course-by-course basis. By and large, most of the commercial support provided to CME courses is well-intended. The current standards and regulations were developed to manage conflicts of interest for individual courses to assure that they remain independent and unbiased. We have to be more thoughtful in assuring that there's reasonably fair and balanced education for physicians. In accepting commercial support for some types of CME activities, we have to work consciously on patching together an overall curriculum of CME activities that addresses participants' educational needs, not just the combined result of several drug companies' marketing agendas.