For several years, many of us in continuing medical education have experienced pushback from transparency regulations. To see how the greater physician population is viewing these regulations, we invited Clark Springs, MD, assistant professor of ophthalmology at the Indiana University School of Medicine, to join us.
To: Clark, Scott
Subject: Transparency and industry funding: Help or hindrance?
We were very excited to have recently been awarded a grant to develop an innovative oncology initiative, but when we reached out to one of our favorite faculty members from past initiatives, we were surprised to hear that he had to turn us down due to new rules and regulations at his institution regarding participation in pharma-funded educational activities. “They are getting more and more restrictive about this kind of stuff and it really hamstrings us,” he told us. “It’s a shame, because I find that I often learn a lot while involving myself in these sorts of things.”
What is the temperature like in your institution regarding participation in pharma-funded education? And how do your colleagues feel about some of the restrictions that are being put in place?
To: Cathy, Scott
It varies by department at my institution. Some academic departments have a strict no-pharma-interaction policy and others do not. I have friends at institutions where there is an institutionwide ban on pharma-funded educational activities, and universally, my colleagues are of the opinion that this position is counterproductive. I have had personal experience with the counterproductive nature of such a policy.
My daughter recently required care from a department that has a no-pharma-interaction policy and she had post-treatment nausea for several weeks that required an antiemetic. The only options offered were a pill or a suppository, neither of which was appealing. A former ophthalmology nurse of mine, who now works in a private setting, informed us that there were other newer options such as dissolvable tablets or sublingual strips (which ended up working much better for her), something she recently learned at an industry-funded CE meeting. I found myself, as an ophthalmologist, educating my academic pediatric colleagues about these new options!
To: Clark, Cathy
I wonder how much of their ignorance was due to the ban on pharma-funded interaction. After all, they are still required to earn their requisite number of CME credits per year regardless of their institution’s stance. I don’t know of anyone who has gone so far as to say that healthcare professionals in their institution cannot attend or complete an online program that is supported by pharma. That, of course, would be impossible to enforce anyway.
From a provider’s standpoint, it certainly is disappointing when we approach faculty about a program who have to tell us, “I’d love to, but I can’t.” Some more creative individuals have figured out a way around the ban, but it is still a nuisance for them. It does not seem that it has gotten significantly worse in recent years, though I suppose if the Sunshine Act is passed with particularly punitive language, we could quickly be looking at a different environment.
To: Scott, Clark
I was at a CME meeting recently where the Sunshine Act was discussed, and I was shocked to find that the majority of the physician audience was unaware of these proposed rules. Yet in their defense, it is still unclear as to how physicians will have to report on a number of things. For example, what happens at a CME/CE meeting where there’s a buffet lunch? Think about it, one could argue that he/she did not partake of the buffet yet still attended the meeting. Who would be the wiser?
To: Cathy, Scott
Those are great points. I am well aware of the Sunshine Act and was initially concerned that patients might misconstrue my consultant relationships with industry. However, I have found that patients like the fact that I am a consultant and that industry is interested in my opinion. Most physicians that I know support full disclosure, as we feel we have nothing to hide and there is nothing inherently wrong with being compensated for our time and effort spent in these activities. There is a need for interaction between practitioners and industry in order for patient care to advance.
To: Cathy, Clark
And yet the lay press is always very quick to jump on the data showing that Dr. X in town Y earned $100,000 in speaker or consultant fees for company Z in 2011, as if he/she is wrong in doing so. I’m not sure how I would feel personally if I knew that my doctor was raking in huge dollars speaking about a specific company’s drug—I think at least I would be more cautious about his recommendations. So far at least, it’s not something I personally have had to deal with.
To: Scott, Clark
Clark, one of the speakers at our recent meeting presented data that supports your experience. And here I was fearful that the public would misunderstand and all this transparency would cause us more grief. Good to know that the general public likes that their docs are considered experts by industry. I was wrong! (Yes, Scott, I admit when I’m wrong.) Hopefully, all the new rules and regulations won’t hinder us from producing valuable education, and I say that from the standpoint of both a CME professional as well as a patient.
Cathy Pagano, CCMEP, is president and Scott Kober, CCMEP, is director of content development at the Institute for Continuing Healthcare Education in Philadelphia. Clark Springs, MD, is assistant professor of ophthalmology at the Indiana University School of Medicine.
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