The ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION issued a Call for Comment on a few proposals that arose from the ACCME board meeting in March:

• Should ACCME create a new designation for commercial-support-free CME?

• Support-Free CME Designation

  Should ACCME develop a designation for programs whose faculty are free of ties to commercial interests?

• Should a third party be created to accept donations for accredited CME activities?

• What do you think of the new ACCME rule-making process?

ACCME posted the responses at its Web site in June, and planned to discuss reactions to the proposals at its board of directors meeting July 16-17. Here's an overview of the responses.

Because some CME providers want to be able to differentiate between CME that does and CME that does not involve some form of relationship with commercial supporters, ACCME proposed a “Commercial Support Free” designation for programs that do not accept any commercial support and do not use funds from advertising or promotion by commercial interests to underwrite the costs of the program. This generated 35 pages of responses, which roughly fell out like this:

Approximately 80 percent of the responses were in the “thanks, but no thanks” category. The main objections included:

The designation is unnecessary, as current ACCME requirements already ensure that accredited CME is fair and balanced.

Teachers and Authors Free From Bias?

It would create the unintended consequence of encouraging the perception that accredited CME that does not allow commercial support is somehow better than that which is supported by industry under ACCME rules. As one accredited CME provider said, “It … seems to imply that commercial-support-free CME is better and deserves special recognition above commercially supported CME.” Another said, “Simply ensuring the honest disclosure of support and whether it is unrestricted or not is sufficient for attendees to make up their own minds about the program.”

It would impose unnecessary hardship on organizations that are unable to hold activities without commercial support. It also would cause confusion for programs that have some activities supported by commercial interests and others that are not, commenters said.

Create a Funding Pool?

Among the organizations that do not support this proposal are the American Medical Association, the Pharmaceutical Research and Manufacturers of America, the North American Association of Medical Education and Communication Companies, and the Society for Academic CME.

The majority of the approximately 20 percent who approved of the proposal, not surprisingly, appeared to be those who do not accept commercial support for their activities or are considering making a move in that direction. As one supporter of the proposal said, “Our organization does not accept commercial support of any kind, nor do we charge registration fees for our activities. Yet we are forced to comply with the overly detailed Standards for Commercial Support. This designation would be perfect.”

Similarly, a proposal to create a designation that would identify a CME program as being “Promotional Teacher and Author Free” seemed to stir up some emotion. Among the positive comments was that it would “clear the air and assist learners in quickly determining whether or not to consider author bias in relation to the CME material's content.” At the other extreme was this comment: “Are you kidding? Please take the folks who come up with these bizarre ideas outside and put them out of their misery.” It was also mentioned numerous times that the title is awkward, making it sound as if no one would be teaching the activity, instead of designating an activity whose speaker has no industry connection. Some said they wanted more clarification before giving the proposal a yea or nay.

About 85 percent of the comments ran toward the negative. Many respondents pointed out that conflicts are already dealt with in the Standards for Commercial Support, specifically Standard 2. There also were concerns that there was no time limit specified; as one commenter said, “Is this a life sentence? This means that anyone who has enough knowledge about a given area to be of value as a consultant to a commercial interest would be banned for life from educating others.” Another said, “Why don't you just add stronger monitoring to what you have [and] get rid of the gray areas?”

Changing the Rules

The third proposal, to create a third party independent of ACCME to collect commercial support funds and disseminate grants to accredited providers, got a lot of responses along the lines of, “I like this in theory, but is it practical?” Commenters wondered if pharma would actually support this proposal, if it would end up costing providers more in administrative costs, and how to ensure that the funds would be distributed fairly. Those who now find themselves on the short end of the funding stick, such as small hospitals, applauded the idea as a way to level the playing field. Roughly 70 percent were against it, at least in its current form.

Those in favor of the proposal pointed out that it would reduce their work volume. One said, “I love this idea … I'd rather send my application to one body and they could then put forth the request to all participating companies.” However, while most on the pro side liked the idea in theory, many suggested that it's not quite ready for prime time.

The naysayers expressed concerns that, as one said, “such a bureaucracy would centralize control of the content of all CME provided in the United States. Whoever controls the money controls everything. … It smells a lot like Big Brother.” Others felt that this isn't something ACCME should be involved with. One called it “mission creep.”

But the most frequently voiced objection was that it would discourage pharma from commercially supporting CME. As one commenter said, “If ACCME seriously believes that companies are going to donate, essentially anonymously, to support this proposed entity, then I think the organization is in serious need of a reality check.”

The final policy put out for public comment related to notice and comment procedures regarding new proposals put forth by ACCME. Basically, it allows the public to comment on policies that “directly and materially impact the ability of accredited providers to conduct business,” and gives people 30 days to make their opinions known.

This was generally well-received, although the caveats ACCME put in place — that whether or not something will be put out for public comment is at ACCME's sole discretion, that it can shorten or eliminate the comment period if it decides a policy needs to be expedited, and that it is up to ACCME to modify, reject, defer, or adopt the policy after receiving comments — rankled some.