Stephen Lewis

For the fifth time in four years, the AMA’s CEJA has insulted physicians’ intelligence and attacked industry grant funding of accredited CME. The CEJA staff and leaders continue to develop opinion statements under the presumption that industry grant funding of CME is inappropriate, despite significant evidence to the contrary.

The result? CEJA is quickly becoming an oxymoron. It is neither ethical nor judicious to ignore evidence that doesn’t support your claims. The staff and leaders of CEJA can’t be bogged down with a little thing like evidence. They say so themselves. A draft of the CEJA report to be discussed by the AMA this month states that CME stakeholders should not be concerned about “whether or how financial relationships influence CME activities.” Instead, we should focus on “the core ethical challenge, no matter what the evidence should prove to be.”

The CEJA seems to have forgotten the critical link that exists between ethics and evidence. Instead, the council proposes that we place a higher priority on perception than we do on the facts.

“Empirical evidence alone is not enough to overcome public skepticism,” according to the AMA CEJA draft report. Careful, CEJA. This stance was already taken during the Salem witch trials. Let’s get back to the evidence. In place of it, the CEJA leaders ask us to pay more attention to “the perception of bias, even if mistaken.” Really?

Let’s get this straight. The AMA CEJA has spent four years and five drafts on a document that asks us to let “the perception of bias, even if mistaken” trump actual facts, “no matter what the evidence should prove to be.”

No wonder AMA members are upset. The CEJA wants to talk about “ethics” in an arena where the organization ignores facts, evidence, and proof. This is bad logic, according to the federal Institute of Medicine, whose 2009 report specifically argued against policies that rely on vague notions of perception. It states, “Some conflict of interest policies refer to actual or perceived conflicts of interest and state that professionals should avoid even ‘the appearance of influence.’ That requirement may lead to confusion.”

Most of the recommendations in the CEJA draft report are benign, but not very useful. In fact, seven of the 10 recommendations made by CEJA already are required by the Accreditation Council for CME and AMA. The other three recommendations are based on the presumption that a grant from industry to fund independent, accredited CME is bad.

The problem is that CEJA does not provide any evidence to support this presumption. The council simply states that there is “growing concern within and outside of medicine that industry funding could have undesirable effects.” Note that half of the references to support this claim come from articles published in 2002 and 2003.

Instead of discussing the fact that industry has the right and the responsibility to fund accredited CME addressing improved diagnosis, treatment, and patient safety, the AMA CEJA demands that we ignore the scientific method that has brought medicine so far since Hippocrates.

At least AMA’s CEJA is consistent.  

Stephen M. Lewis, MA, CCMEP, is president of Littleton, Colo.–based Global Education Group. He can be reached at slewis@globaleducationgroup.com.

Update: Since this column was posted, the Association of Clinical Researchers and Educators has issued a statement asking the AMA House of Delegates to once again reject CEJA's report. You May Also Be Interested In:
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