Thursday, February 7, 2008

Sloan-Kettering to Commercial CME: "You're Outta Here!"

Memorial Sloan-Kettering Cancer Center, which is ranked the second best cancer center in the nation by U.S. News and World Report, has just achieved another impressive distinction--it has banned commercial funding of CME throughout the institution. In a fascinating article, Dave Kovaleski of Medical Meetings Magazine describes a process that began in July 2006, when the hospital's physician in chief, Robert Wittes, MD, decided to take this bold action in order to keep medical education "purely educational."

This is an instructive case study of how a large institution can wean itself off industry CME support and end up with a stronger educational program. Thomas Fahey, M.D, who chairs the CME committee, has overseen the transition and says that "I don't think there's any evidence to show that the extra money made CME better." In fact, Fahey feels that the new environment "keeps the focus where it should be--on education--and that comes across to participants."

The hospital had received 25% of its CME budget from industry, and in order to make up the shortfall they "de-fancified" their programs. For example, they shifted conferences from hotels to hospital conference rooms, they stopped paying for physicians' lunches, and they recruited more internal faculty members to speak. Apparently, it is still possible to convince physicians to educate their colleagues without the incentive of a fat check. They also increased the fees physicians must pay for some courses by 10-20%.

And what has been the response? Are physicians boycotting these meetings because they are too cheap to pay for their own education, as many defenders of commercial CME warn is inevitable? No. Attendance has remained steady and there have been no complaints.

Obviously, Sloan-Kettering is a particularly well-funded institution, and it can draw on stellar faculty to give CME, both of which make its industry-free transition smoother than it will be for other hospitals. Nonetheless, it provides a encouraging example of what is possible when the leadership decides that it's time do the right thing.


vbjmd said...

Thanks for posting this--is it possible to post it so that it can be downloaded or emailed? I'd like to send it to various hospital MDs, including the CME committee.

Daniel Carlat, M.D. said...

Here is the url of the article:

They can also access it by clicking on the link in the article. I doubt the magazine would want me to try posting the article separately.

Anonymous said...

See,"Who's Afraid of Industry-Sponsored CME?
No Pharma Funding at Memorial Sloan-Kettering Cancer Center."

Anonymous said...

Perhaps the 'target' is not the pysicians, nor the CME companies, nor Big Pharma. After all, it is the US Federal Laws that guide these interactions that should be targeted for allowing tax incentives to Big Pharma this way in the first place.

Ultimately, oiling the squeaky wheels of our dying uninsured patients is served by allowing the present Status Quo.

This discussion dovetails very directly with the building political pressure to make some major changes in the very foundation of the Broken US healthcare delivery system. And that answer lies in Universal Healthcare for all.

How does this appy to this discussion? Because, it is the political answer to the underlying problem. Capitalism and Medicine do not mix well. It either needs to be open market OR single payer system. Not our dysfuntional mess we have.

There is no reason Big Pharma cannot continue to exist making their wonderful progress and money for shareholders, while we physicians move into a fair, academic guided system that most all other countries have found success with (Like the VA here I might add).

The political tide will change this in the next year or two so we may as well get ready. I, for one cant wait. But then again, I must disclose I do not supplement my income whoring myself at speaking engagments, now or ever.

Good Job Dr Carlat! Now, lets put spotlight on these laws that allow and promote pyhysicians / Big Pharma conflict of interest in the first place.