I was excited to hear at the Alliance for CME annual conference about the community's new advocacy initiatives, and in particular, the drive to collect data to demonstrate CME's positive impact on patient care and to determine the prevalence of commercial bias. CME leaders were forthright in acknowledging that they don't know what the data will show — it may, in fact, reveal that the Senate Finance Committee and other critics are correct in their assessment that commercial support erodes CME's independence. (See conference coverage, page 24.)
Regardless of the outcomes, I think the data collection projects are a big step in the right direction. It's urgent that the CME community demonstrate its contributions to the healthcare system. But as speakers pointed out at the conference, even if the results show that pharmaceutical funding does not create a significant problem with commercial bias in CME, the prevailing opinion in the wider healthcare community and in the government is that physicians should pay for their own education, just as other professionals do.
And no amount of positive data will uproot the perception that the CME community's ethics and professionalism are seriously compromised by the more than $1 billion in funding it receives annually from the pharmaceutical industry. Just after the Alliance for CME conference, the Senate Finance Committee initiated a new investigation — this time into two medical societies' financial ties to drug companies, including grants for meetings. (See story, page 21.) The SFC is convinced that CME is a marketing tool. Since the government focus on controlling healthcare costs and reining in pharma marketing practices is only going to intensify, the CME community needs to take further action on two fronts.
First, I believe the move toward curtailing commercial support is inevitable. The CME profession needs to take charge and analyze the numerous alternatives to the current funding model. As Mike Saxton, Pfizer, said during a hot-topics panel at the Alliance meeting, it's better for the CME community to propose its own solutions rather than have other groups impose their views. He recommended that the community establish systemwide standards, such as funding caps. Otherwise, each company will set its own restrictions. Already, several pharmaceutical companies, including Pfizer, have added questions on grant applications about how much industry funding providers receive.
Second, the Accreditation Council for CME needs to take much tougher action to address the Senate Finance Committee's concerns about the holes in its oversight system. The ACCME has ramped up its data-collection process — now it needs to go further and require providers to include questions about bias in activity evaluations (as many do already), and submit those results. Further, the ACCME appears to be still struggling with adopting a stricter enforcement model. But that is the most important change the ACCME needs to make to mitigate government concerns.
I understand and respect the ACCME's reluctance to become the CME police. And I certainly understand CME providers' reluctance to limit funding. But it's only by making fundamental changes to the financial and accreditation enforcement models that the CME community will begin to establish its credibility and reduce the threat of government regulation.