Conflict of interest in medical research, education, and practice has been one of the most hotly debated topics that the Institute of Medicine has ever tackled, reported Todd Dorman, MD, member of the IOM's conflict-of-interest committee. He spoke during a session at the National Task Force on CME Provider/Industry Collaboration annual conference, held in October in Baltimore. IOM, a private organization based in Washington, D.C., was established by the National Academy of Sciences to act in an advisory capacity to the government and public on matters related to health.
Dorman, who is associate dean and director for CME at Johns Hopkins University School of Medicine in Baltimore, explained that normally an IOM committee meets three or four times on a topic. The COI committee met six times. Most committee meetings last a day, but COI meetings were usually one and half or two days long, with one meeting lasting three days. Four of the six sessions had time set aside for public input. Overall, during the course of more than a year, IOM received thousands of public comments on the issue, far more input than committees usually gather.
IOM's meetings and hearings are now complete and the report is being drafted, said Dorman. The timeline for public release is February or March. While the findings won't become law or mandated as policy, policymakers and legislators will weigh heavily the recommendations of IOM, commented audience member Bruce Bellande, PhD, CCMEP, president and CEO, CME Enterprise, Carmel, Ind.
What's the Solution?
Panelists representing organizations that have provided comment to the IOM explained their views during the session. Representing the pharmaceutical industry perspective, Cathryn Clary, MD, MBA, vice president, U.S. external medical affairs, Pfizer, N.Y., said eliminating commercial support is not the answer. Greater transparency, multiple funding sources per activity, separating CME from promotional speaking in all venues, and supporting performance improvement CME are some steps that industry can take to further mitigate against COI. In addition, companies should increase grant requirements, examining providers' organizational conflict of interest, for example.
Dave Davis, MD, vice president of continuing healthcare, Association of American Medical Colleges, Washington, D.C., discussed the recent report AAMC issued regarding conflict of interest in CME, which recommended that academic medical centers should establish central CME offices, develop audit mechanisms to ensure compliance, and discourageparticipation in pharmaceutical companies' speakers bureaus. He also proposed that the CME community create a conflict-of-interest toolkit, including materials for faculty, and a Web site where CME professionals can share best practices.
To read the full written responses from these and other organizations, go to www.iom.edu/CMS/3740/47464.aspx.
Sidebar: SACME Members Speak
Responding to a poll,
of Society for Academic CME members said they agree that current funding approaches lead to bias in CME;
also said that commercial support is essential for CME.