If an industry rep invites a physician to an expensive dinner featuring a local speaker, should the doctor go? That was one of the questions posed to the approximately 280 attendees at the 12th National Conference on CME Provider/Industry Collaboration, sponsored by the American Medical Association, held October 16 to 18 at the Baltimore Marriott Waterfront Hotel. Speakers used an audience response system to poll participants on hot issues.

The responses to the above question elicited much laughter — and pointed up the divide in the CME industry as to what constitutes ethical relations between physicians and pharma firms:

  • 33 percent said the doc shouldn't go;
  • 35 percent said the doc should participate;
  • 31 percent said they would have to think about it.

The AMA's Ethical Opinion on Gifts to Physicians from Industry states that gifts must have no strings attached, benefit patients, and be of minimal value, usually defined as under $100. But if conference participants — whom we might assume are people especially motivated to learn about ethics since they spent the time and money to attend — are so uncertain about the application of those rules, imagine the confusion among the ranks of practicing physicians, industry reps, and CME providers.

But it has become increasingly urgent for the medical field to understand and practice the rules, said plenary speaker Alan R. Nelson, MD, former AMA president, chair of the Working Group for the Communication of Ethical Guidelines for Gifts to Physicians from Industry, and special advisor to the executive vice-president, American College of Physicians — American Society of Internal Medicine, Fairfax, Va. Government and public criticism of pharma/physician relations continues to grow, he said. In its 2002 work plan, the Office of the Inspector General (www.hhs.gov/progorg/oig) states that it will evaluate whether the $12 billion pharma spends annually on marketing to physicians creates ethical problems for doctors. And the Kentucky Board of Medical Licensure sent a letter to physicians this spring expressing its concern that “industry money and influence has permeated all levels of physician CME.” It stated that it will use the AMA's ethical principles as a basis for evaluating complaints about physician/pharma relations.

To help reverse the trend of ethical violations, the AMA, in partnership with 30 organizations including specialty societies and pharma firms, has launched an 18-month educational initiative. An informational packet has been mailed to CME providers and other organizations across the country. An ethics education kit, including a lecture with slides, can also be downloaded from the AMA Web site (www.ama-assn.org). More resources will be posted in 2002.

But Will Doctors Listen?

Persuading physicians to follow the rules will be a challenge. said speaker Norman B. Kahn Jr., MD, vice president, science and education, American Academy of Family Physicians, Leawood, Kan. Physicians feel “overhassled” and underpaid, he said. They feel entitled [to gifts], and they don't think they are influenced by them.

Another complex point is patients' perception of gifts. Take the example of a notepad and pen embossed with drug names versus a medical textbook, said Kahn. “The patient will perceive the textbook as more appropriate, but it often costs more than $100.”

Quid Pro Quo

Accredited CME conferences are also under a public spotlight. The television show “20/20” sent a team undercover to a national meeting this year to expose pharma promotions in the exhibit hall, one speaker reported. The intensifying scrutiny makes it all the more important for CME providers to strictly adhere to guidelines, speakers stressed. And societies are strengthening their ethical parameters, said Kahn. “Five years ago most medical societies would rent a theme park and hold a big party [at their annual meetings],” he observed. That still happens, he said, but many organizations don't accept corporate money that gives the appearance of violating the AMA guidelines.

While unethical relations attract public attention, we mustn't forget the positive relationships between CME providers and industry, reiterated Frederic S. Wilson, manager, CME, Health Care Research Group, Procter & Gamble Pharmaceuticals, Mason, Ohio. Pharmaceutical companies support more than half of the CME produced, he said. Refuting the concerns about undue influence, he quoted an article in The Lancet, which concluded that the educational activities studied were not compromised by pharma patronage.

Dangerous Questions

Most attendees agreed. When asked whether gifts, donations, and commercial support given to medical societies influence the prescribing practices of individual physicians, 25 percent said yes, 58 percent said no, and 17 percent said they didn't know.

“Do medical societies' relationships with commercial supporters imply a quid pro quo? This is a very dangerous question,” Kahn said. “What if gifts and donations to medical societies did change physicians' prescribing practices? We would no longer be in the Accreditation Council for CME's safe harbor.”

On the other hand, Kahn asked, “What if the relationship was found to have no impact — what does that say about the value of CME?”

MECCs Hold Inaugural Meeting

Some people in the CME industry said it couldn't be done — the formation of an organization comprising medical education and communications companies — entities that usually compete, not collaborate. But the inaugural meeting of the North American Association of Medical Education and Communications Companies (NAAMECC) proved the doubters wrong.

Held during the American Medical Association Conference on CME Provider/Industry Collaboration in October in Baltimore, the organization's debut meeting drew about 45 attendees.

One impetus for the development of NAAMECC was the recent spate of articles in both the general and medical media that criticized MECCs. “We need to do research and publish data. We have to answer questions and criticism with numbers and data sources,” said Jacqueline Parochka, NAAMECC co-founder; and vice president and director of education, Discovery International, Deerfield, Ill.

In addition to promoting understanding about MECCs to other providers, outside organizations, and the media, NAAMECC aims to examine ways to elevate the best practices of MECCs.

Currently, 16 organizations have joined as charter members. Organizations that are not MECCs may join as associate members. The next meeting of NAAMECC will take place during the 2002 Alliance for CME annual meeting in Orlando; it is tentatively scheduled for 6 p.m., February 1, at Disney's Coronado Springs Resort. For more information, contact Mark Schaffer, NAAMECC co-founder; and vice president of CME, Professional Postgraduate Services, Secaucus, N.J., at (201) 271-6205 or mschaffer@pwcg.com.