Tuesday, July 21, 2009

New ACCME Report: Commercial CME Support Enters Free Fall

Once a year, the ACCME (Accreditation Council of Continuing Medical Education) releases its Annual Report detailing the state of the health of the CME enterprise. It reports various things, like how many CME courses have been offered, how many physicians have taken part, etc.... But the meat of the report is always on page 8, Table 7: "Income and Expense by Organization Type".

This year, the big news (though not that newsy to those who have been following the issue) is that for the first time since financial records were reported in 1998, the size of the CME industry has contracted. In 1998, the total income for all CME activities was $888 million, and over the years, it steadily increased to a high of $2,539 million in 2007. Well, last year, the total dipped to $2,365 million, a "loss" of $174 million.

Why do I put the word loss in quotes? Because virtually this entire shortfall was accounted for by a decrease in commercial support for CME. Commercial support dropped from roughly $1.2 billion in 2007 to $1 billion in 2008. This is actually good news, because drug companies support CME in order to encourage doctors to prescribe the newest and most expensive drugs, even when these drugs have no advantages and, as often happens, have more severe side effects than older agents.

But the news is even better than this. Drug companies are wisely electing to pull their money out of the most corrupt and biased of all CME-providing entities--the for-profit Medical Education and Communication Companies. As you can see in this chart
put together by my assistant who painstakingly entered years worth of ACCME numbers into an Excel spreadsheet (note to ACCME--shouldn't this data crunching be your job?), commercial support for MECCs has entered free fall mode. In 2007, drug companies forked over $594 million to MECCs in order to promote their newest and most expensive products; last year, they reduced the spigot to $463 million--a decrease of $131 million, or a 22% drop.

And believe me folks, the 2009 report will look even worse for MECCs. Pfizer has announced that
it will no longer fund them. The American Psychiatric Association is ending industry sponsored symposia, all of which are administered by MECCs. The AMA, in its latest CEJA report, said that commercial funding should be allowed only if the CME provider is deemed "not overly reliant on funding from industry sources." Translation: for-profit MECCs will no longer be kosher. (I realize this second CEJA report has been sent back to committee to tweak language such as "ethically permissible" but the language regarding MECCs will likely survive). Finally, the Institute of Medicine has called for a drastic reduction in commercial support of CME.

So goodbye MECCs. Your Christmas and Hannukah lasted a long time, but it's finally winding down.


Howard said...

Nationwide, prescription pills have become a societal force. Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug. Meanwhile, direct-to-consumer drug marketing that touts new and expanded uses has become widespread. Adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications.

Michael S. Altus, PhD, ELS said...

"So goodbye MECCs."

Not necessarily, Danny. The MECCs are geared up to provide communication services. They are where the talent resides. With decreases in corporate support of CME, ACCME-accredited organizations, which already include some MECCs, will charge participants. The days of free-CME might be coming to a close, which will irritate participants accustomed to the culture of entitlement that asserts that one should not have to pay. No matter. Those who are begrudging about paying will do so because they have to have CME credits or want to learn something new and keep up-to-date.

Disclosure: I have provided writing services for corporate-supported MECCs.


Michael S. Altus, PhD, ELS
Intensive Care Communications, Inc.®
Biomedical Writing and Editing

Anonymous said...

I agree that pharma found a vacuum in education and filled it. But why is that the most highly educated and trained in our country cannot critically apprise clinical data? Why can't they use their brains to challenge pharma data? Are they victims? Dupes? Lazy? Every resident should learn to read clinical data and ask questions. But this yet another example of the victim mentality in America.

I think CME and physician learning and outcomes will become a powerful tool to understand gaps in knowledge and guess who will find a way to fill that gap...pharma. They dont have to use CME just use the outcomes as market knowledge.