Michael Saxton

In a move certain to spark great controversy in the continuing medical education community, pharmaceutical giant Pfizer announced on July 2 that it will no longer award grants to medical education companies. "We are eliminating support for commercial CME providers, whether they are for profit or nonprofit, and regardless of whether they have firewalls,” says Mike Saxton, MEd, senior director, team leader, medical education group, Pfizer, New York. "Our intention is to send a signal that funds must be used exclusively for independent education. We think this is the responsible decision at this point in time in order to help demonstrate and even preserve the opportunity for industry to support quality education."

Up until this announcement, Pfizer had awarded 17 percent of its CME funding to medical education and communication companies in 2008. "That figure will now drop to zero," says Saxton. (In May, Pfizer began posting its grants to medical, scientific, and patient organizations, as well as its charitable contributions, online here.

Saxton clarifies that this move is not a blanket condemnation of medical education and communication companies. "Some of the best providers out there are MECCs and some of the worst are MECCs, so it is unfortunate that this action will not allow us to give direct support to quality MECCs,” he says. Pfizer will continue to fund CME initiatives that involve MECCs, he says, as long as they're not the primary sponsor. “MECCs’ role is critical. Patients would clearly lose if MECCs were not part of the equation. They’re innovative, they’re efficient, and they have competencies that other provider groups often lack. The best model for MECCs is to collaborate with hospitals, associations, and academic medical centers."

Pfizer is making this move, Saxton says, in part, because of the widespread perception among the healthcare community and the public that MECCs blur the line between education and promotion. The U.S. Senate Finance Committee report on CME, released in April 2007, which concluded that CME was sometimes a marketing tool for the pharma industry, focused almost exclusively on medical education companies. The Josiah W. Macy Foundation Report, issued this spring, excluded MECCs from its list of organizations that should be eligible For Accreditation Council for CME accreditation.

The perception issue is fueled by the fact that education companies receive more commercial support than any other provider type. According to the ACCME Annual Data Report 2006, publishing/education companies received $621 million in industry support, more than half of the $1.1 billion total. Industry funding accounted for 76 percent of MECCs' total income, a bigger percentage than for any other group.

In addition to the perception problem, Saxton says Pfizer is extremely concerned about some MECCs' business practices, particularly their use of business development personnel who are compensated financially based on the amount of funding they bring in. Under Pfizer's new CME process, launched in January 2008, CME providers must go through a qualification process, and the team has tried to screen for MECCs that use such a business development model, but without success. “We’ve made what I consider a Herculean effort to ask questions on our new application to get at these issues and it simply has not worked,” says Saxton. "We’ve been disappointed and frustrated by our inability to get verifiable data about issues that we consider very important. We do not have a way to be certain that the data is accurate; in fact, we know in some cases it’s not accurate. Short of hiring more people to audit [organizations], we can’t verify the independence of these groups."

Saxton points to the Code of Ethical Principles and Standards of Professional Practice, issued by the Association of Fundraising Professionals, which states that people should not accept compensation of any kind that is tied to the amount of money they bring in. “I started sending this code of ethics out to some groups and asking them explicitly, ‘Does your organization support this?’ I've been getting mixed reviews." As for why Pfizer is excluding nonprofits as well as for-profits, he answers that “the distinction between a for-profit and a nonprofit in the MECC world is meaningless. We see nonprofits acting just like the for-profits in terms of some of those business practices."

Pfizer’s exclusion of MECCs includes those that have developed firewalls between their marketing and educational arms, even those that are or will be approved under the ACCME's new policy, released in August 2007, which requires MECCs to alter their corporate structures so that they are completely separate from sister companies involved in marketing. (MECCs that have a parent company involved in marketing are no longer eligible for accreditation.)

But Saxton says the business development practices Pfizer is concerned about "create an irreconcilable conflict of interest with independence that is not currently addressed by the ACCME system at all. The MECC community will appropriately point out that as a group they’re more in compliance than other provider groups, but noncompliance findings are often for relatively minor issues involving paperwork and ignore more fundamental conflicts of interests that aren’t even being looked at or discussed. As the accreditation system becomes less paper-driven and more outcomes-driven, then the ACCME’s data will be more relevant to this discussion. Today, it is only one piece of information and we know it is not sufficient. It’s a minimum standard."

Saxton acknowledges that there are independence issues with other provider types, but says they’re not as institutionally engrained as they are with MECCs. "It doesn’t mean that we’re ignoring conflicts of interests in those other settings. We have excluded providers in every setting for some of these same reasons, but the issue was just not on the same level of magnitude."

For more on Pfizer's new CME process, visit https://www.pfizermededgrants.com/pfizercme/ and watch for the July/August issue of Medical Meetings.

To comment on this development, please send e-mail to Tamar Hosansky at thosansky@meetingsnet.com.