Change keeps coming. It doesn't take a genius to read the tea leaves here. To us, it signals a potential system collapse. Let's look at two incidents that have taken place recently:

• In June, the U.S. Senate initiated an investigation of the major pharmaceutical companies' practices of awarding educational grants. Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) of the Senate Finance Committee said they want to ensure that grant-giving is not just a “backdoor way to funnel money to doctors and other individuals who can influence prescribing and purchasing of prescription medications, particularly off-label prescriptions.” Baucus added that while he supports drug companies funding educational programs, he is concerned “that some grants may be for purposes other than education.” The Committee asked selected companies to supply details on grants awarded back to 2000, policies and procedures for awarding grants, and the names of decision-makers at each company.

• In June, the Seattle Times ran a series of articles, which have been reprinted in newspapers around the country, about how drug companies create markets. The point: Physicians have been influenced by the creative promotional activities of pharmaceutical companies over many years, which has resulted in skewed medical information. The articles advise consumers to ask their doctors about their pharmaceutical company relationships.

  As you know, the CME community is already making major changes in response to increased scrutiny. CME providers are currently reshaping their relationships with MECCs:

• Major universities and private education companies are examining whether to joint sponsor CME with communication companies that have deep financial relationships with industry. If they do, the CME activities must be based on identified educational need and be compatible with their CME mission statement.

• Many national specialty societies are tightening control over the content of CME jointly sponsored with education and communication companies. Their focus is on reducing costs of noneducational aspects of their activities (such as costly meals and receptions and excessive costs for promoting the activity), and they are turning their attention to needs assessments, curricula design that links needs to desired results, and outcomes studies.

We anticipate more dramatic changes ahead. Consider the possibility that this intense public attention could result in the establishment of a national pool of educational funds. Those funds would then be granted to recognized educators and institutions based on a set of national health priorities or competencies.

Change Course Now

CME providers should take steps now to develop strategies for funding their activities that don't rely solely on industry monies.

Pharma has changed course and is evaluating grant requests based on the ability to affect physician behaviors relative to patient healthcare outcomes, so address those educational needs and desired results clearly in your grant applications, and be prepared to describe the methods to measure the outcomes.

While much of this change has already happened, major changes take time to be recognized. Expect the scrutiny to continue to increase. Many experts in organizational dynamics say that the timeliness of these investigations, the significant change in the context in which grants are being given today, and attention of the policymakers are all signs that a collapse in the system we have known and used for two decades is near. But a system collapse does not necessarily mean a bad ending; indeed we think the outcome will be better for the public health. The bywords are “prepare alternative strategies now.”

Steven M. Passin is president of the CME consulting firm Steve Passin & Associates LLC in Newtown Square, Pa. He has also served as deputy health secretary for California. Contact him by e-mail at passin@passinasssociates.com. Susan O'Brien is senior associate, Steve Passin & Associates LLC. Contact her at obrien@passinassociates.com.