It's no longer a question of whether commercial support will be eliminated -- the question is when -- and how stakeholders will accept the transition.
We are in the midst of an overdue transformation in the way medical education is conceived, produced, and funded. In any time of transformation, there are both winners and losers. In this case, the major losers are institutions dependent on commercial funding of CME.
As both a practicing physician and as the owner of an accredited CME provider, I have been an outspoken critic of commercial support, and I have shared thoughts with many medical education leaders. It is increasingly clear to my colleagues and me that the question is no longer whether commercial funding will be divorced from CME; the question is when it will happen. Will the stakeholders accept this inevitable transition gracefully, or will they fight it to the bitter end, thereby damaging their reputations and their businesses in the process? Unfortunately, all appearances lead me to conclude that the latter will be the case.
Why am I so certain that commercially funded CME is breathing its last? The ultimate customers of CME — the physicians themselves — are demanding this change. Within the last eight months, three influential reports written primarily by physicians have been released, sending shock waves through the CME industry.
Last November, the Josiah Macy Jr. Foundation issued the summary of its report, concluding that “bias, either by appearance or reality, has become woven into the very fabric of continuing education.” The full report represents the definitive exposition of the distorting influence of industry funding on medical education.
Then, in April, the American Association of Medical Colleges Task Force on Industry Funding of Medical Education issued a report recommending that all 129 American medical schools should ban drug company food and gifts and should discourage faculty from speaking for drug companies. While the report formally left the door open to commercial CME, it directed that medical schools should audit such programs for bias. Finally, the Council on Ethical and Judicial Affairs of the American Medical Association — the very group that defines what constitutes CME credit — recommended that medical institutions no longer accept industry funding for medical education, CME or otherwise. (The proposal was referred back to committee and may be considered again next November.)
The responses to these reports from CME trade groups and other stakeholders have been unproductive: the rote citing of chapter and verse of Accreditation Council for CME policies and blanket denials of improprieties. Unfortunately, this is not going to cut it. We physicians have decided to wrestle back control of our medical education, and it is time for education companies to realize this and to partner with us responsibly.
I recommend that CME companies dependent on commercial support announce their intentions to divest their certified CME activities from commercial funding sources and outline a reasonable timetable for the transition. Most companies will remain solvent by becoming developers of unaccredited CME, a sufficiently lucrative enterprise that receives industry funding of $20 to $60 billion annually, according to the Macy report, as opposed to $1.5 billion for certified CME. A minority of companies will choose to stay in the certified CME business and will derive income from direct contracts with medical societies and academic medical centers.
Upton Sinclair wrote: “It is difficult to get a man to understand something when his job depends on not understanding it.” It is time for just that understanding.
Daniel J. Carlat, MD, is assistant clinical professor of psychiatry at Tufts University School of Medicine; and editor-in-chief of the Carlat Psychiatry Report, Newburyport, Mass. He has written about the pharmaceutical industry for the op-ed section of The New York Times, and is currently writing a book about the state of American psychiatry, to be published by Simon & Schuster. Reach him at dcarlat@comcast.net.