Wednesday, May 27, 2009

ACCME's Good Courses, Bad Courses--Mystery Solved?

According to an anonymous source, ACCME’s newly proposed “Commercial Support Free CME” did not arise directly from ACCME. Rather, the idea was hatched in response to pressure from the American Board of Medical Specialties, which apparently takes a very dim view of industry-supported CME.

Here’s the background of this increasingly complicated issue.

As I wrote in a prior post, the ACCME has floated the concept of distinguishing two different types of CMEs—a Commercial Support Free CME versus the standard "anything goes" industry-funded CME (see this report
from their March 2009 Board meeting for the details.) This has struck many as a strange idea: the national certifying body presents a refined definition of superior vs. inferior education, but at the same time declares that they would happily accredit inferior education anyway.

The plot got even murkier after the American Medical Association’s Council on Ethical and Judicial Affairs (CEJA) recently released its second effort at defining the ethics of industry funding of medical education. In their first report,
which was released last year, the committee proclaimed that companies should not pay for doctor’s education when those same companies stand to benefit financially from the content of the education. While that made eminently good sense, it angered a subculture of doctors who prefer not to pay for their own education, so the proposal was tabled, and the committee was directed to come up with a more palatable version of medical ethics, which they recently released. This document, like ACCME’s proposal, proposes the same surreal notion of two CMEs: one that is “ethically preferrable” (involving no commercial support) and another that is only “ethically permissable” (funded by drug companies).

Essentially, the world’s premier medical organization is saying that while we should strive for the best ethics, dodgy ethics are also acceptable—at least when a lot of money is at stake.

Well, I finally solved the mystery of the two CMEs. At the heart of this case is neither the ACCME nor the AMA, but rather the American Board of Medical Specialties (ABMS). The ABMS sets the standards for maintenance of specialty board certification. Depending on your specialty, you have to undergo an exam or other evaluation process every few years so that you can continue to call yourself a “Board-Certified” psychiatrist, cardiologist, dermatologist, and so on. Apparently, the ABMS, realizing that industry-funded CME is quickly losing the public's trust, would prefer to no longer allow doctors to submit commercial CME as part of their requirements. But in order to be able to distinguish commercial CME from non-commercial CME, ABMS needed help from the organization that accredits CME, namely, the ACCME. So they asked the ACCME to create a separate Commercial-Free CME designation. ACCME complied, and the result is the proposal and call for comments posted on their website.

I called ABMS to verify they they are the force behind ACCME's proposal, but I was told that this was a "misunderstanding." I then went to my source, who said that ABMS is backtracking because of angry comments from medical societies. Finally, I contacted ACCME to find out if the Commercial Free CME designation was, in fact, prompted by ABMS, and I am still awaiting their response.

Does any of this really matter? Who cares who came up with the idea, or who pressured whom? It matters because we all deserve to know exactly where our major medical organizations stand on issues that are crucial to the public health. And the education of physicians is one of the most crucial issues of all.


James M. La Rossa Jr. said...

I have little doubt that the Carlat Blog will get to the bottom of whether the American Board of Medical Specialties (ABMS) were, in fact, behind the ACCME's newly proposed Commercial-Free CME or not, and where major medical organzations stand on these issues in general. It should be noted, however, that the FDA endorses the ACCME standards as the barometer of whether medical education can be sponsored by industry. And there has been no talk, as far as I can tell, of eliminating sponsored Category 1 CME.

In following, I offer one important legal caution. As the sole arbiter of medical-legal industry guidelines, unless the FDA is willing to re-write its rules to recognize a "new legal standard," the ABMS is, in effect, "regulating speech," by differentiating (or in this case, de-authorizing) between two kinds of (potentially) identical speech. If the ABMS is "backtracking," as your source claims, it might be because the Board has realized that it could be throwing the first punch in a costly First Amendment battle.

In other words, in a Nation of Laws, no medical society, however well meaning, should be capable of circumventing federal regulations through an arbitrary recognition of one kind of legally permissible speech over another. Should the ACCME and, in turn, the FDA, endorse the ABMS' de-authorization of sponsored Category 1 credit, it might eliminate the Free Speech complication, but would signal the end of ALL industry sponsorship — something physicians should be aware.

Yours very truly,
James M. La Rossa Jr.
Medworks Media Global
Los Angeles, CA

Anonymous said...

Good grief, this CME business is out of control! Hello! There are sick people out here and the U.S. ranks 15th (Canadian Conference Board, 2009) or worse, 37th,(WHO 2000) world rankings of principle health indicators among nations (all spending much less per capita than we do).

Granted, it is hard to contemplate letting go of all the cash, but trying to hang onto it is creating a level of shady convoluted work arounds that would embarrass even the Massachusetts state legislature - and that's saying a lot!

If the pharmaceutical industry is sincerely interested in health (trying to keep the sarcasm out of my voice) then they should just donate education money to a neutral organization which will allocate money to the CME industry on the basis of thoughtful discussions with members of the medical professions. I nominate Dr.Marcia Angell to head this endeavor to be ably assisted, perhaps, by Drs. Carlat and David Newman, author of "Hippocrates' Shadow" (highly recommended).

I'm a lay person, but sit on two community advisory boards for Clinical Translational Science Institutes working with caring and thoughtful physicians and medical researchers. Watching their work and good will being constantly subverted by an uncaring and profit driven health industry is almost as painful as watching the baleful affects of this broken system on the members of the low income community groups I work with.