Two days after it issued its April 25 report on CME, the United States Senate Committee on Finance followed up with a letter to the Accreditation Council for CME, highlighting its concerns that the ACCME’s oversight is insufficient to guarantee that programs are independent of drug company influence.

The ACCME'’s review process does not necessarily detect whether providers are catering to commercial supporters by favorably presenting their drugs in activities -- and if providers are slanting content, they're not necessarily violating ACCME policy, the letter said. In fact, the Committee's review suggests that CME providers could say that they control content and have full independence, even though they allow commercial supporters to influence content. The senators also said they found it "troubling" that the ACCME accredits providers if 80 percent of their activities are found in compliance, allowing some activities to fall below standards.

The Committee is now waiting for a response to its letter to the ACCME before it determines its next steps, according to a committee spokeswoman.

“We don’t reject or refute [the Senate Finance Committee's] observations,” says Murray Kopelow, MD, chief executive, Accreditation Council for CME. Click here to share your views anonymously. The full Finance Committee report is online here) For the Senate Finance Committee's letter to the ACCME, click here.)

As the ACCME said in a press release, the report’s observations highlight where there could be enhancements to the system that would make CME's independence from commercial interests more distinct, he says.

In fact, Kopelow says, the ACCME has already begun examining the effectiveness of the updated Standards for Commercial Support and the accreditation process. The ACCME held a plenary session at its March board meeting with a “conflict of interest consultant talking to us about all the points in the system where influence and relationships are present and could be present, and how those facts and circumstances might influence [CME],” Kopelow says. "The updated Standards address personal conflicts of interest, such as faculty relationships with industry; now it's time to begin discussions about organizational conflicts of interest."

As for the SFC’s concern that pharma companies influence content, Kopelow says, “We’re going to have to recognize that perhaps some of the current practices have become obsolete. When a commercial supporter suggests or directs the content of CME, that’s an action that undermines, challenges, or removes the [provider’s] independence. If a commercial supporter makes a suggestion that is followed because [the provider] wants to get more money next time, even if the provider takes full responsibility for accepting the input, it does not ensure the independence of continuing medical education.

“It is probably reasonable to believe that CME can receive money from industry without receiving any advice or guidance, either nuanced or direct, on the content of the activity or who should deliver it. We need to ask the question: Can collaboration with industry and independence from industry co-exist in continuing medical education? The terms industry partners and collaboration with industry imply a relationship that’s not consistent with the spirit of the ACCME’s Standards of Commercial Support.”

For further analysis and developments, watch for upcoming issues of Medical Meetings magazine.