With physician/pharmaceutical company relations under an unrelenting media spotlight, medical community leaders are increasingly concerned about rooting out ethical violations in CME. For-profit medical education and communication companies are frequent targets.

“We have turned down some business because a commercial supporter wanted us to do something we could not do.”

To dispel some of the misperceptions and encourage a productive dialogue about the role of MECCs in CME, two companies, Meniscus Educational Institute and Discovery International, conducted a survey of their colleagues. We asked Karen Overstreet, leader of MECCA, the medical education and communications company provider section of the Alliance for CME; and president of MEI, a for-profit firm in West Conshohocken, Pa., to discuss what their preliminary data shows.

Q: Last time we talked, you mentioned that although there is a perception that communications companies get most of their revenue from pharmaceutical firms, your data shows that MECCs have many sources of revenue.

A: Only 72 percent of [survey respondents] get any funding from pharmaceutical companies, 13 percent get some funding from other for-profit companies (which could be other MECCs), 26 percent get some funding from medical device companies, 11 percent from managed care organizations, 9 percent from government grants, and 46 percent [checked off] “other,” which includes participant fees and anything that didn't fall into the other categories.

Q: However, according to the Accreditation Council for CME's 2000 Annual Report, about 93 percent of communications companies' income comes from commercial support, a higher percentage than for any other type of provider. Why do you think that is?

A: MECCs often rely on commercial support because they usually do not have parent organizations with large budgets such as medical schools or specialty societies. To develop CME, they typically seek grants from external sources.

Q: In the MECCA session at the Alliance for CME conference in January, attendees talked about voluntary firewalls they had set up at their own companies. One participant said the CME division of her company had incorporated as a nonprofit. Would you expand on the steps communications companies take to protect the independence of their accredited CME programs?

A: Even though we are not required to have internal firewalls, most MECCs do anyway. Companies that do both educational and promotional work typically make a strong effort to keep them separate so there is no possible perception of bias. If they have both an accredited and non-accredited division, they often have separate staffs, and separate budgetary and financial planning systems.

I think MECCs need to be mindful of the fact that they may come under additional scrutiny. We need to do the highest possible quality work we can and exceed the requirements of the Standards for Commercial Support — not just what is written in the Standards, but their spirit.

One other tidbit: the MECCA provider section of the Alliance e-mailed all members to see how many are for-profit and not-for-profit. Forty-three companies responded: 91 percent are currently for-profit, and 14 percent of those are considering changing their status to not-for-profit. That's becoming more common because of this feeling that somehow being for-profit is bad. Being not-for-profit is just a tax designation. In my experience, for-profit and not-for-profit companies operate very similarly.

Q: What do you do when commercial supporters try to bend the rules?

A: It's tricky because our accreditation is on the line, and we must maintain our integrity. We also want to stay in business. We haven't lost a client, but we have turned down some business because a commercial supporter wanted us to do something we could not do.

Q: The new ACCME firewall policy, for FDA-regulated providers, stipulates that providers ask participants if they detected commercial bias in programs. Do you think all providers should do that?

A: My company has asked participants to rate the amount of commercial bias in our activities for years. In most programs, more than 90 percent of them rate our freedom from bias as good or excellent. Many MECCs do this even though they are not required to. It's an easy thing to do, just add one question to the evaluation form. I'm not sure why everybody isn't doing it.