Talk to any medical meeting planner about satellite symposia — industry-supported educational events held in conjunction with, but independently of, an organization's meeting — and one word pops up over and over again: control. After all, these symposia are being held during the meeting's dates, they're attended by the meeting's participants, and they're often supported by the meeting's biggest exhibitors.
To gain that control, you have to have policies and procedures in place — and make sure that they're followed. That can be a lot of work, but many planners, like Debbie Smithey, CMP, director, educational meetings and CME, American College of Emergency Physicians in Irving, Texas, say it's worth the hassle. “Our members enjoy them, and they are beneficial educationally, so we allow them. It's a nice trade-off, a win for ACEP, our satellite supporters, and our registrants.” They also can be a lucrative form of income for the main meeting organization, which can charge anywhere from $2,000 to $20,000 and up.
The amount of control you need to have is proportional to the distance the official meeting sponsor wants to keep between itself and the satellite organizers: The closer you are, the more control you need to have. MM spoke with representatives of three organizations that had differing degrees of separation to find out more:
- At Arm's Length
Smithey's organization, ACEP, maintains the greatest distance from these events by not offering the option of providing CME accreditation for satellite symposia.
- The Middle Ground
Jan Richards, educational program development manager, Society of Interventional Radiology (SIR), Fairfax, Va., says her organization keeps the symposia separate from the official program yet offers a CME accreditation option.
- Welcome to My World
James W. Thompson, MD, deputy medical director with the American Psychiatric Association, Washington, D.C., says APA actually integrates these symposia into its official meeting.
No Competition Allowed
When it comes to scheduling, total control is a must, say Smithey, Richards, and Thompson. “We have to have some control over when these activities are held around our meeting, since it's our members who will be going to them,” says Smithey.
“If we have something going on, we do not allow any satellite events,” says Richards. Her organization includes a list of approved satellite event times in the information it sends out to potential supporters, along with a warning that they cannot begin prior to the official start times listed (e.g., the bus can't come to pick people up for an off-site event before the official program's closing time, even if the satellite event itself doesn't start until the unrestricted time).
Thompson says the APA doesn't allow commercially supported symposia to compete with the rest of the program, which is not commercially supported. But APA's integration of satellite symposia into its official program also brings lots of regulation that goes way beyond scheduling: “If you saw the committees and staff I have just to keep an eye on these things, it would boggle your mind,” he sighs as he flips through his 4-inch-thick satellite symposia policies-and-procedures binder.
Even though ACEP isn't the accrediting party for satellites held around its annual scientific assembly, satellite sponsors have to make an application to the college if they want to provide education. “They provide us with detailed course content, recommended, and the number of registrants they expect,” says Smithey.
The educational meetings committee chair reviews the applications to make sure the symposia will add to the completeness of the overall education for official meeting attendees. “Even though it's not a program we're putting together, it is at our meeting, and we feel a certain responsibility for what's presented to our members at one of our venues,” she adds. SIR also is careful about overlapping content. “I work with the other members of our annual meeting committee,” says Richards, who handled the CME portion of two satellite symposia held in conjunction with SIR's annual meeting this year. “I would require an outline, bios from all faculty members, what they're going to talk about, full disclosures [of their financial relationships with pharma companies], and any discussion there might be of off-label use. All the things that I require for my regular educational programs I require for my satellite symposia.” That goes for whether or not SIR is doing the CME accreditation.
Thompson says the APA, which has 40 to 50 of these symposia each year, amounting to some 250 individual talks out of the 2,500 talks provided in the overall annual meeting, goes a step further. The association's members submit the topics, which then are reviewed blind as to whom the supporter might be. “The author or chair submitting the presentation is our member, and they sign a piece of paper saying ‘these are my ideas.’ They have to take responsibility for it.”
Once the program committee approves the topics as scientifically acceptable, “we give the whole list to potential supporters, who then pick the sessions they're willing to support. We don't ask for the support until after the fact,” he says. And while most of the symposia they support are pharmacologically oriented, sometimes pharmaceutical companies can be surprising. “One company picked up a symposium on ethics not long ago. They just decided that would be a good thing for them to support,” Thompson says.
Faculty also can be a factor: Smithey says ACEP and its educational meetings committee recently revamped its satellite guidelines to prevent faculty who are teaching topics in its educational program from presenting similar topics and tracks at satellite events. The reasoning, she says, is that even with full disclosure, and even though ACEP is not the accredited sponsor for the satellite, some people might view presenters doing a lecture on the same topic for a commercial entity that they are doing for the official program as a conflict of interest, as outlined by Accreditation Council for CME and American Medical Association rules. “To avoid even the appearance of a conflict, we just don't permit it,” she says.
Ban the Balloons
APA insists on being able to approve every advertisement for commercially supported symposia held at its meeting. “They can't run it unless we've approved it,” says Thompson. It doesn't stop them from trying, though. He tells of one communications company that thought it would be a good idea to send out balloons printed with information about its symposia to private practitioners. “Doctors started calling us,” he laughs. “We called one of the supporting company's vice presidents, who hadn't known about the promotion, and it was pulled immediately.”
APA does allow commercial companies to send out mailers to people registered for the meeting, and it also lets them put an advertisement in the association newspaper — with all the appropriate CME language included. Companies can put up a sign in each of the APA's core hotels, and a limited number of signs in the convention center. They are not, however, allowed to advertise their symposia in the exhibit area.
ACEP also allows mailings to its meeting registrants, and even provides them with a set of mailing labels. “We also allow them to use our meeting logo — not our college logo, our meeting logo — on their promotional materials, but they have to include a statement that the program is not affiliated with the American College of Emergency Physicians,” says Smithey.
“Some organizations allow them to paper the chairs in the meeting rooms with promotions — we don't,” says Richards. SIR does allow them to have two posters: one near the exhibit area and one near registration. And if the hotel lets them put posters up elsewhere? “We're fine with that.” Also, she says, if the supporter is also an exhibitor, “which 99.9 percent of them are, if they want to distribute a flier at their booth, that's their business.”
“Since we're not giving AMA credit, we have a different perspective about on-site monitoring” for satellites, says Smithey. “But a lot of our members attend, and believe me, we hear from them [about problems].” ACEP sends 50 staff members to the scientific assembly, many of whom sit in on the presentations. She also asks for registration information afterwards “so we can track how our members attend their events.” Although SIR's satellite symposia were monitored by an independent third party, Richards showed up at both symposia to keep an eye on them herself.
The APA has a several-tiered monitoring process, says Thompson. “We have a physician, usually a psychiatric resident, sit in on each of the commercially supported presentations with a comprehensive checklist. We have another monitor who's checking for things such as whether industry representatives are staying clear of the area, and to make sure there aren't any signs up for pharmacological products.” The APA gets evaluations on individual speakers from all participants that asks specific questions such as, “Did the presenter stress the supporter's drug over others?”
They also record all the sessions. If a monitor comes up with a problem, or if the bias scores are more than a standard deviation from the mean, “we pull the tapes and have psychiatrists with extensive checklists review the tape. If they say the presenter went beyond the pale, the committee on commercial support will issue a warning or sanctions,” Thompson says.
APA has sanctions for noncompliance with its regulations. If a presenter is found to be in violation of the rules, they first get a warning letter telling them that if they commit another violation, they won't be allowed to present at future APA meetings. “That's all we usually have to do,” he says. “We've never had to actually pull somebody's right to present.” In fact, he says one commercial supporter complained that one of its presenters, who got a warning letter previously, wouldn't even mention their drug. “That was a bit much,” he says. “But it shows just how seriously presenters take warnings.”
“It's very useful to have a very high-level contact” in the supporting companies, he explains. They can help nip problems in the bud and facilitate quick resolution of problems that occur on site. “We talk to them throughout the year,” he says. “We have a meeting in July [APA's annual meeting is held each May] where we talk with all the symposia supporters about issues and problems. We can inform them of new CME policies, and they can tell us when they think we've overstepped the bounds. I'm not saying it's perfect, but it works pretty well for us.”
PhRMA's NEW CODE: More Fellowships, Fewer Shrimp?
While this article focuses on satellite symposia, there are several other kinds of satellite events commonly found at, including social events and extracurricular activities, such as golf outings, parties, and receptions. Now that the new Pharmaceutical Research and Manufacturers of America's Code on Interactions with Healthcare Professionals, which is similar to both Accreditation Council for CME and American Medical Association ethical guidelines, has gone into effect, predictions are that the scope and nature of these satellite social events will change — if commercial supporters follow them.
“I would hope they do follow the new guidelines,” says Jan Richards, educational program development manager with the Society of Interventional Radiology in Fairfax, Va. “When I read that they no longer can bring a spouse to dinner, I realized just how much cutting back they'll have to do.” Whether or not they'll follow the new guidelines remains to be seen, but, as Richards points out, “At some point the bad publicity they get may not be worth these events'value. Stay tuned, because we'll have an update as facts and figures start coming in.”
Cutting back would be good, but cutting them out altogether would be better, says James Thompson, MD, deputy medical director with the American Psychiatric Association in Washington, D.C. “Over the past five years we've tried to convince companies that these are not seemly or helpful to anybody. We've sat down with high-level people at these companies and explained that when you start renting out SeaWorld, it gets a little obscene. And they do listen: There are fewer, a lot fewer of these social events than there used to be. We'd like to see them gone altogether.
“Our medical director is always telling [industry executives] that what we want is more resident fellowships and less shrimp. I think that's a really good mantra,” says Thompson.