Sen. Franken, however, wasn't buying his argument. In later questioning, Franken said, “Just because medicine … is a lot better now than when we were kids, that doesn't mean that industry should fund CME. That doesn't follow.”

James Scully, MD, medical director and CEO, American Psychiatric Association, added to Stossel's claim that industry funding has led to advances, saying, “many of the most dramatic improvements in the effective treatment of mental illness have come as a result of newer and better medications. These … would not have been possible without the commitment of the pharmaceutical industry to research and development.” However, he also said that it is important for physicians and CME providers to continue to “re-examine the pros and cons of their relationships with the pharmaceutical industry. Where are the real and perceived conflicts? How can they be eliminated? This is the process that many medical societies are undertaking.” That includes the APA, which recently altered policies and its code of conduct on accepting industry funding for educational programs. For example, the APA board this year voted to phase out industry-supported education programs and industry-supported meals served at APA scientific meetings. The cost, Scully estimated, will be about $1.5 million in lost revenues. “In the long run, however, we believe that the elimination of even the perception of possible undue influence is worth the cost,” he added.

ACCME Pulls No Punches

The final speaker at the special hearing was Murray Kopelow, MD, chief executive of the Accreditation Council for CME, who appeared ready to defend his organization after Nissen's testimony that “Maybe [ACCME doesn't] have resources, maybe they do not have the will. We need ACCME to go away.” Not so fast, said Kopelow.

“Senators, ACCME is the firewall between promotion and education,” he said. “Accredited CME is independent from the influence of commercial interests.” The total revenues of CME providers are about $2 billion, half from learners, half from commercial interests, Kopelow said. However, the relative proportion of CME supported by industry dollars has been in a downward slide since 2003, and in 2008, total commercial support dollars fell by $200 million. He emphasized that while 80 percent of providers accept commercial support, 15 percent of providers receive 80 percent of that support — it's not distributed evenly across the CME enterprise.

Half of the CME in this country is not commercially supported, Kopelow added. “Most CME is happening in small hospitals and county and state medical societies, and it's not commercially supported. It's independent.” When Sen. Franken asked if ACCME wouldn't mind making the distinction between promotion and education clear for the other half that is commercially supported, Kopelow was quick to shoot back: “That line is not blurred in our CME enterprise. Those stories you've heard, that was another time and another place. Our accredited providers clearly draw the distinction and separation between promotion and education.”

One example Kopelow outlined was a new policy that just went into effect that excludes from accreditation any entity that markets, distributes, or resells healthcare products or services. He also discussed recent ACCME proposals that, he said, in many ways resembled some of what had been presented by Morris of the U.S. Department of Health and Human Services, such as creating a new entity independent of ACCME to pool unrestricted educational donations from commercial interests that would be available to accredited providers. When the ACCME floated this idea to its stakeholders earlier this year, most of those who commented deemed it problematic, but Kopelow said it was still on the table. Other ACCME proposals still under consideration include eliminating commercial support altogether from accredited CME, allowing commercial support only under certain conditions where it is in the public need, and not allowing accredited providers to receive any communications from commercial interests related to specific content. (For more on these and the rest of the recent ACCME proposals put out for public comment, go to meetingsnet.com and search keywords “Care to Comment.”

In the meantime, Kopelow said, ACCME has gone on to enhance enforcement of its policies. It continues to offer clarification on its independence criteria and is maintaining its complaints-and-inquiries process for accredited providers whose practices are called into question. It also has developed a new Web-based activity database system to capture information that describes providers' CME activities, including ultimately being able to help monitor any bias toward a particular drug or device.