If the U.S. catches cold, the whole world of medical education gets sick,” proclaimed Martin E. Cearnal, president and CEO, Physicians World Communications Group, Secaucus, N.J., as he kicked off the Sixth Annual Meeting of the Global Alliance for Medical Education. Held June 24 to 26 at the Princeton Club in New York City, the conference attracted about 100 attendees and faculty from Europe, Asia, Australia, Canada, Latin America, and South America, as well as the U.S.

Cearnal's no-holds-barred keynote focused on the hot issue of the relationships between pharmaceutical companies, physicians, and CME providers — a controversy that Cearnal says will impact the global growth of CME. Investments in education are increasing, so “How can we possibly fail?”

Tree 'n' Flee, Gas 'n' Go

Roadblocks come from things like headlines in the U.S. about so-called dine 'n' dash meetings, he said. Drawing laughter from the attendees, Cearnal described more promotional tactics: tree 'n' flee, where doctors browse a Christmas tree lot for a free tree while hearing a product pitch; gas 'n' go, where docs fill up their tanks on a company tab while listening to a rep; and wash 'n' run, where they drive through a car wash with a rep.

“This has got to stop,” he said. Cearnal concluded, “We have runaway [health care] costs, disenchanted doctors, a dysfunctional health care system. The market is starting to sneeze. If education looks like promotion, it will get regulated like promotion.” And promotion disguised as education will continue to fuel criticism worldwide, Cearnal warned. “Education companies worldwide must agree to the same guidelines for balanced content and scientific integrity and must rigidly uphold those standards.”

Providers Educate Pharma

Currently, however, there are no global standards regulating CME, as there are in the U.S. Also, pharmaceutical companies outside the U.S. do not have medical educational offices, for the most part, and marketing executives don't understand the difference between education and promotion, pointed out Lew Miller, founder of GAME, and chairman of Intermedica Inc., in Darien, Conn. This affects the ability of CME providers to get international commercial support, and to maintain control over pharma-funded CME.

Gonzalo Lopez, MD, director, Education Medica Continua Ltda., Santafe de Bogota, says that Columbia has “developed an [educational] presentation for [pharmaceutical firm] marketing managers.”

In Brazil, “We have started a quarterly newsletter [to educate] pharmaceutical marketing managers about the value of CME,” said Pedro Vera Garduno, president, Intermedica, Darien, Conn., and Mexico City.

In Canada, a conglomeration of pharma companies are developing a mandatory course for all drug reps, said Linda Snell, MD, director of research and development in CME, McGill University, Montréal.

Criticism Spurs CME Growth

There is a an up side to the increasing criticism of the medical community. In countries like Japan and Australia, the public, media, and governments have pressured for regulation of physician education. While CME is still voluntary in most countries, changes are forthcoming, speakers said.

• As of 2000, CME is required by law in Australia. CME is already mandatory in New Zealand, Croatia, the Czech Republic, and Slovenia.

• In the United Kingdom, where CME is also mandatory, the national regulatory body is trying to introduce an annual “revalidation” system for physicians, with CME being an important component.

• Mandatory systems are in the works in Germany, France, Ireland, Italy, Spain, and the Netherlands.

Reciprocity Update

At last year's conference, the American Medical Association and the European Accreditation Council for CME announced a credit reciprocity agreement. U.S. doctors attending European conferences, which are approved by the EACCME and the AMA, can obtain AMA PRA credit; and European doctors attending U.S. meetings can exchange AMA credit for credit in their own countries, as long as the country's national authority gives its approval. To date, 45 activities have been approved under the reciprocal system.

The agreement applies only to specialists, but now the the European organization of general practitioners is considering developing its own system, modeled on the EACCME.

Next year's conference will be held June 24 to 26 at McGill University in Montréal.