Monday, April 27, 2009

ACCME's Existential Crisis

ACCME (the Accreditation Council for Continuing Medical Education) knows what it needs to do, but it is having a very hard time bringing itself to do it.

The pharmaceutical industry funds over half of all the education U.S. doctors receive, which is an embarrassment to our medical establishment and a danger to patients. Whenever I tell my patients that drug companies are in charge of most medical education, they react the same way--they shake their heads in an "are you serious?" expression of disbelief.

ACCME knows this system is inherently wrong but it also know that most of its income is dependent on the system.

Its latest effort to distance itself from the corrupted system over which it presides is to create a new category of "Commercial Support Free (TM)" CME. It's a strange proposal. It implies, of course, that CSF-CME (as I'll abbreviate it) is an essentially different kind of medical education from industry-supported CME. After all, if it were not different, then there would be no point in creating a separate category.

And how is CSF-CME different? It is presumably better in some way, because it is not tainted with the biasing influence of industry. As the industry-friendly journal Medical Marketing and Media has put it, the new designation is an official "Good Housekeeping Seal" for CME.

But herein lies the rub. The entire mission of the ACCME is to accredit only the cream of the crop of medical education. If it is now proposing to create a platinum category of truly unbiased CME, then what does this mean for industry CME? That it isn't very good. And now ACCME has boxed itself into a difficult position. If it is creating a second class citizen category of "not-as-good" medical education, why accredit it at all?

Perhaps this is a way for the organization to gradually transition toward a ban on commercial funding, a ban which the Board of Directors has announced is not in the cards any time soon. Thus, CSF-CME may be part of a 5 year plan to gradually wean CME off of industry funding. Here's how it would work. You create a category of the "best" CME, and, under the theory that "if you build it, they will come," you hope that doctors will naturally gravitate away from the phony tin courses and toward the platinum courses. This would hasten the shift of drug company money away from CME, and would make the eventual ban on industry funding a little less painful.

But, like gradually peeling off a bandaid, it won't really make it less painful for the MECCs--it will just make it more protracted, and more like slow torture. It's much better to simply rip the bandaid off in one fell swoop. The pain is harsh but brief, and we can all move on.


Bernard Carroll said...

Is there reason to think that ACCME actually does safeguard the integrity of CME? I for one am not aware that ACCME has applied sanctions to any commercial CME provider or to any academic programs that launder industry money. Is ACCME a Potemkin village?

Anonymous said...

I thought I had found an exemplary CME program. The website read:

"The Massachusetts General Hospital Psychiatry Academy is an interactive community where physicians and other health care professionals can access world-renowned education that improves clinical practice in psychiatry."

Hidden among all the other information was this website, which shattered my fantasy: