Thursday, June 19, 2008

ACCME Gets Serious with "New Paradigm"

Given AMA's recent decision to slow down on CME reform, these new guidelines proposed by ACCME are more than welcome. The ACCME is focusing on the epicenter of commercial bias, which is the choice of topics to be covered in CME programs. As I have detailed in my last two posts, the cutting edge technique for ensuring that CME contains promotional content is to choose topics that are in line with the sponsor's commercial interests. The resulting course may be a scientifically accurate portrayal of a carefully pruned topic, showing no obvious "bias" within that topic area. But it is promotional nonetheless, just as drug company advertisements are promotional even though the FDA oversees them to ensure scientific accuracy.

The new guidelines will not allow MECCs to choose the topics; instead, they will chosen in consultation with relatively unbiased government agencies and medical societies. The one aspect of the "new paradigm" that is a head scratcher is the stipulation that CME be "free of bias." That's been a requirement for years, but has never been enforced. It appears that the organization has beefed up enforcement efforts--the say they have put 10% of providers on probation for breaches of their Standards of Commercial Support, up from 1% in the past.

We'll all have to stay tuned.

4 comments:

James M. La Rossa Jr. said...

Dan:

Just a few questions regarding the ACCME's proposed “new paradigm.”

Paradigm 1:
"Needs assessments are performed by organizations that do not receive commercial support or have relationships with industry, such as government agencies..." THERE IS NO GOVERNMENT AGENCY THAT HAS ANY BACKGROUND OR KNOWLEDGE-BASE IN MEDICINE THAT DOES NOT CURRENTLY HAVE A RELATIONSHIP WITH INDUSTRY. SHOULD WE MAKE A NEW GOVERNMENT AGENCY? AND WHO WILL PAY FOR IT? LET'S PUT THAT TO THE OBAMA AND McCAIN CAMPAIGNS AND SEE WHAT KIND OF RESPONSE WE GET.

Paradigm 2:
"Practice gaps are corroborated by bona fide performance measurements of the learners' own practice, such as the National Quality Form..." WHO WILL CORROBORATE THE CORROBORATORS? THE NEW GOVERNMENT AGENCY? THE ACCME? IF SO, WHY AREN'T THEY DOING IT ALREADY?

Paradigm 3:
"Content comes from curricula specified by medical societies and agencies such as the AMA, AHRQ, ABMS, FSMB..." WHAT WILL THEY CHARGE FOR GIVING YOU SAID CURRICULA? WILL IT BE STANDARDIZED BY THE NEW GOVERNMENT AGENCY? ISN'T THIS THE BEGINNINGS OF (ANOTHER) TURF BATTLE? PERHAPS THE BATTLE OF ALL BATTLES! WATCH WHAT HAPPENS WHEN THE APA SQUARES OFF AGINST THE AMA TO DETERMINE WHO WILL WRITE CME CURRICULA FOR PSYCHIATRISTS, FOR EXAMPLE! LOBBYISTS, START YOUR ENGINES!

Paradigm 4:
"CME is verified as being free of bias." THIS IS NOT A PARADIGM. IT IS THE RATIONALE BEHIND WHY THE PARADIGM NEEDS TO SHIFT.

I have done my best to keep up with the expert opinion on the Carlat Psychiatry Blog these last six months. If all we get after all the sweat so many of you have put into trying to resolve this dilemma is these "four paradigms," then I am sorry for all of us. Please tell me that there is more here than meets the eye, DC!

James M. La Rossa Jr. said...

At the expense of admitting that I, too, have become rather polemical on this issue, let me just conclude that I am contented to read such a succinct analogy about the potential end of all this, DC. Thank you.

Daniel Carlat, M.D. said...

James,

Of course I agree with you that this is not the definitive solution. It is like tinkering with a faucet in a condemned house--the whole structure is eventually going to have to come down. At some point, the cost and hassle of implementing the ACCME's incremental patches of the system are going to equal the income to be made from industry CME, and the system may just start withering a natural death.

Bernard Carroll said...

For a new case study of corrupted CME, see here.
http://hcrenewal.blogspot.com/2008/06/medscapes-cme-ethics-part-ii.html#links