Monday, August 27, 2007

ACCME's "New" Policies, Translated

On 8/24, ACCME announced 7 new policies that will go into effect as of January 1, 2008. Some of these were probably motivated by the Senate Finance Committee's critical report, but I assume that these don’t represent ACCME's definitive response (or at least I desperately hope not!). You can read the new policies yourself here, but unless you have been through an application for accreditation, as I have, don’t expect to understand what is being said. I’ve taken the liberty of translating each of their impenetrable pronouncements below, along with some commentary along the way.

New Policy # 1: If you make an agreement to provide a CME activity for a drug company, make sure to sign the document. Huh? This is new? It's a little bit alarming that this needs to be spelled out.

New Policy # 2: Drug companies are no longer allowed to tell you how to produce the CME they sponsor. Okay, I guess this is an admission that, in fact, companies had been able to directly influence CME content for all these years. I’m shocked, just shocked.

New Policy # 3: If you produce a web-based CME program, you can no longer conveniently leave off the fact that it is industry-sponsored from the first few web pages, as many providers were doing. This was a rather slimy way of roping doctors into an activity before they realized that it was just another promotional fluff piece. Thus, this policy enhances disclosure. Problem is, disclosure by itself does nothing to prevent promotional content. It only provides the illusion of objectivity.

New Policy # 4: Drug companies can’t put links to CME programs on their websites. This allows providers to more effectively hide the fact that you are about to watch a drug ad in the guise of education. Bad idea.

New Policy # 5: You know all that pesky disclosure stuff that we’ve always required you to do? Well, now we’re serious. You really have to do it. And this is a new policy…how???

New Policy # 6: We’ve changed our official definition of “commercial interest.” But don’t worry, after listening to the concerns of all the for-profit Medical Education Communication Companies, we’ve made certain that our new definition won’t disrupt business as usual. The crux here is that a “commercial interest” is not allowed to produce CME. As you can imagine, any redefinition of commercial interest generates high anxiety among MECCs. To the rest of the world, any company that makes all of their income by taking grants from drug companies and producing education that relates to their products, would be defined as a “commercial interest.” But somehow, ACCME has tweaked, massaged, nay, Shiatsued language as we know it to ensure that MECC’s remain blissfully non-commercial. This way, they can continue to make loads of money!

New Policy # 7: If you teach a CME activity, you can get two hours of CME credit for every hour of credit you teach. Excellent! That nets me 24 extra CME credits per year for writing The Carlat Psychiatry Report! Now this is policy I can get behind.

Bottom-line: The status quo finds ever more elaborate ways of maintaining the status quo.


Anonymous said...


You've done a wonderful job in bringing potential CME-sponsored conflicts of interest to the forefront.

Now that many of the problems have been noted, perhaps it is time for your readers to undertake a vigorous debate on how they would change CME it was up to them?

For whatever it's worth, here are my two cents worth: For decades now, people a lot smarter than I am have built this (CME) thing into a behemoth of complexity. Everyone has a different take on it. GSK will sponsor something that Pfizer won't, and vice versa. There is even profound disagreement in the U.S. Senate. So, I would tear the whole thing up and focus on the group of people that all of these regulations are supposed to help: Physicians.

First, merge Category 1 and Category 2 CME. Period! There's no need for both. If society cannot trust physicians to abide by the honor system, than we have bigger problems than medical education can cure. When you read a journal or attend a symposia, put the pretest, posttest and answer key in a file in your office. If you're audited you have the proof that you have been continuing your education. The medical community is a much better over-seer than the ACCME. As an MD, if you don't keep up with new science, patients—some of whom walk and talk like doctors as it is—will flush that out and make your life miserable. God forbid if you are litigated against. The amount of continuing education, or lack thereof, can come into play in court. So, it is in your personal, professional, and, perhaps, legal interest to get together with colleagues at meetings to hash things over. Enforcement becomes moot.

My second change would be that only teaching institutions can offer CME. The private medical education companies can still set-up the program, but it must pass muster from the university. Remember that all of the test grading, etc., the university would normally do has been waived, since the physician is now keeping her own records. So, the university is saving money which can be passed on to the end-user. The ACCME can monitor the
universities if they so choose, and—most importantly—standardize fees. Yes, BMS should pay a larger fee for putting on a program than should a small association or patient advocacy group. But the fee should be on a standardized, sliding scale that is universal throughout the University CME system. The end result is that the doctor gets the CME for free. That should be axiomatic—no matter who sponsors the program.

James M. La Rossa Jr.
Editorial Director & Publisher
Los Angeles, CA.

Anonymous said...

A previous post states: "If society cannot trust physicians to abide by the honor system, than we have bigger problems than medical education can cure."

I'm afraid we have "bigger problems than medical education can cure."

Two points, first CME. One facility I know of used to distribute CME program evaluations at the beginning of each CME lecture. One day, it snowed heavily. 15-20 minutes went by, and no speaker showed. Finally, the facility got a call. The speaker had been en route, but due to the weather conditions he was turning around and going home.

When the attendees filed out and the dust settled, to the great chagrin of the DME, it was discovered that over 40 signed and fully filled out evaluations had been turned in by the facility's MDs, ostensibly for the purpose of obtaining full credit for participation in a CME activity.

The DME disclosed that his evals specifically stated something to the effect that "by signing the eval, the attendee certifies that s/he has spent at least 40 minutes attending the medical lecture."

As the DME relating the incident bemoaned the blatent abuse of the "honor system," all I could think of what that scene in Casablanca, where the police captain storms into Rick's Cafe bellowing, "I'm shocked, *shocked* to find gambling going on in this establishment!" and up toddles one of the casino cashiers, simpering, "Your winnings, sir." Without missing a beat the Captain says, "Thank you!" and accepts the cash before rounding up the usual suspects.

So much for the honor system.

Call me a cynic. People lie, cheat and steal, and even kill. Doctors are no exception.

Socond point, as a research professional, I am deeply offended by the comment "patients—some of whom walk and talk like doctors as it is—will flush that out and make your life miserable."

Doctors need to accept that (gasp!) there are people out there in other professions besides themselves who possess knowledge, discernment, reasoning ability and often extraordinary intelligence.

I have a friend in the computer industry who posits that the wealth of information out there will eventually make doctors obsolete in the way that other information industries that had monopolies on access to knowledge are being forced out of their comfortable niches. Consumers are already able walk through the same diagnostic algorithms doctors use online. How many times have I seen a doctor run to UpToDate in Medicine to answer a question? How hard is that? What kind of discernment is the doctor using when relying on one single source to make decisions about patient care?

Get over yourselves, doctors. Your arrogance and greed fuel these problems. Do you really think we laypeople don't see through this?