Tuesday, May 20, 2008

AMA Ethics Committee Wants to Ban Industry-Sponsored CME

The American Medical Association's main ethics committee (CEJA, or the Council on Ethical and Judicial Affairs) has released this report on medical education declaring that doctors and medical institutions "must not accept industry funding to support professional education activities."

To quote further from the report's executive summary:

"... Medicine must ensure that the values and core commitments of the profession protect the integrity of professional education. It must strive to deliver scientifically objective and clinically relevant information to individuals across the learning continuum. To promote continued innovation and improvement in patient care, medicine must sustain ongoing, productive relationships with the pharmaceutical, biotechnology, and medical device companies. However, industry support of professional education has raised concerns that threaten the integrity of medicine’s educational function."

The report goes on to recommend the banning of industry-supported CME, but does allow for one exception, which I found quite reasonable:

"Exception should be made for technical training when new diagnostic or therapeutic devices and techniques are introduced. Once expertise in the use of previously new devices has developed within the professional community, continuing industry involvement in educating practitioners is no longer warranted."

This would allow, for example, companies to pay for orthopedists to train surgeons in how to fit the latest artificial hips, or to hire cardiologists to teach physicians how to program the newest pacemakers. These are examples of the few cases in which the companies have special expertise that can't be learned via standard educational outlets, such as professional journals. Note that this exception does not apply to pharmaceuticals, because doctors can best learn about drug prescribing by reading and evaluating the medical evidence.

What are the chances that the AMA will adopt this recommendation? Here is a list of the many 2007 and 2006 CEJA recommendations which were approved, indicating that the organization is likely to take this new report very, very seriously.


Supremacy Claus said...


1) Quasi-governmental organization. The AMA is a quasi-governmental organization. It can put a doctor on trial. If it sanctions a doctor, the doctor faces similar problems as if sanctioned by a licensing board. Its enacted, official policies will also influence courts as laws and regulations might. (Do doctors know that courts defer to expert policy pronouncements, and that they should decide these carefully?)

As such, it must meet some standards of proof for its utterances. It should adhere to the US Constitution, as other regulatory bodies must. That includes the Free Speech Clause and the Freedom of Association Clause of the First Amendment. I read the report you cited. It is missing something.

A compelling fact of harm, justifying the regulatory abridgment of these rights.

Why don't Levine and the AMA have the same rights to express their subjective opinions? Because they have regulatory powers.

Levine, a biased, left wing ideologue, forgot to discuss something from the Fifth Grade, the US Constitution.

2) Conflict of Interest. The AMA is a CME provider. It competes with these programs, yet failed to plainly disclose that in the first line. The AMA depends on drug company advertising. If other forms of advertising get banned, where will the unspent money go? Correct, into AMA publications. I consider the CME credits available in its journals and meetings to be industry sponsored CME. The value of the discount on its journals from the revenue from drug company ads exceeds that of most give aways. A court should force the AMA to adhere to its own Anti-Sponsorship Policy if it gets enacted, or suffer exemplary damages for knowing violations of its own self-dealing policy. It must either end advertising and keep CME credits. Or keep advertising, and stop all CME activity. The blatancy of drug company advertising is far greater in its conventions, meetings, CME activities and in AMA journals than in any sponsored CME activity by others.

3) The AMA has an obligation to present an unbiased assessment of a situation to its Board and members. Levine presents only one side of the problem. The report shows bias by lack of balance.

Anonymous said...

The link to the AMWA ethics committee report, "Industry Support of Professional Education in Medicine" goes to an incomplete version. For the complete version including references, go to >www.ama-assn.org/ama1/pub/upload/mm/471/ceja1-2.doc>.