New Initiative Will Teach Faculty the Differences Between CME and Promotion

I realize this headline sounds farcical, like something you'd read in the Onion (“Bush Calls for Panic”) but in fact it was on the first page of the October newsletter from the Alliance for CME, a CME trade group. Yes, the MECC industry has finally admitted that the difference between industry-funded CME and drug promotion is very difficult to puzzle out. So, in concert with Pfizer and Audio Digest, they are creating a 45 minute internet course to teach hired guns how to thread this perplexing needle.

According to the article: “Medical education faculty who complete the 45 minute online activity will have their names added to the National Faculty Education Initiative verification database.” That’s a sentence-full. Basically, take the course and you get to advertise yourself to MECCs looking to hire speakers to promote their clients’ drugs. Did I say "promote"? I meant educate about their sponsors' drugs. Wait—what I really meant was educate about a topic area in which the sponsor has a commercial interest. Oh darn, I’m still confusing CME with promotion. Obviously, I need that course.

Interestingly, it was only two months ago that another CME trade group—the North American Association of Medical Education and Communication Companies (NAAMECC)—ripped into Business Week, complaining that the magazine was “propagating falsehoods and false accusations.” At issue was this article on the CME industry, in which Business Week defined MECCs as a “little known breed of marketing specialists.”

The outraged trade group wrote that “The article’s assertion that continuing medical education (CME) has become “one of the most profitable businesses” for “marketing firms” falsely equates independent, certified CME with pharmaceutical marketing and promotion.”

But given this most recent educational initiative, I think that NAAMECC owes Arlene Weintraub, the article’s writer, an apology. If the faculty who specialize in teaching CME need a custom-designed course to divine how industry CME is not promotion, it’s hardly fair to rake a journalist over the coals for having "confused" the two.

The Wall of Commercial Bias Keeps Crumbling Down

It's rare for an industry-friendly magazine like Medical Meetings to feature an article opposed to commercially-sponsored CME. And rarer still for the editor-in-chief to preface the issue with an editorial in support of this position. But we are seeing a historic sea change in public opinion, and the unpredictable is becoming commonplace.

First, read Tamar Hosansky's editorial, Fast-Track CME Reform. In it, she discusses the recent annual conference of the Alliance for CME, a trade group that supports commercial CME. After mentioning another trade group's announcement that it will start collecting data to audit bias in commercial CME (calling all hens--leave henhouse immediately!), Hosansky states her own opinion: "First, I believe the move toward curtailing commercial support is inevitable." Hardly naive, Hosansky appreciates "CME providers' reluctance to limit funding. But it's only by making fundamental changes to the financial and accreditation enforcement models that the CME community will begin to establish its credibility and reduce the threat of government regulation."

But the jewel of this issue comes later on, in Donna Beales' article entitled "5 Steps to Building Real Firewalls." Beales is the CME Coordinator at Lowell General Hospital in Massachusetts. It's unusual for a CME professional who stands to benefit from industry funding to take such a strong ethical stance. Or, as Upton Sinclair once said, "It is difficult to get a man to understand something when his job depends on not understanding it."

Beales argues, among other things, that physicians with commercial interests should be ineligible to present CME programs. I'll quote at length from this part of her article, but please go to the original to read the whole thing (I have bolded some passages in the second paragraph; the bolding in the third paragraph is in the original text).

"Increasingly, it's becoming a standard across all industries to disclose commercial interests. On most boards, if an individual has any conflicts, it's expected that he or she will be recused from voting on any issues that might involve personal gain.

Choosing to be a physician is a noble calling. Choosing to be a drug company representative may have lucrative financial returns for a doctor who is burned out with medical practice. Both are free enterprises. It's time to choose between one or the other — teaching, or hawking. They are not one and the same. In fact, education and enterprise are mutually exclusive. It's time for doctors to get back to the business of doctoring, and for those with aspirations toward the world of commerce to depart the profession for greener pastures.

If we're worried that we won't attract anyone to teach due to the lack of financial gain, then it's time to look at the whole structure of CME. No other educational program in the U.S. is free of charge to participants. Perhaps it's time to entertain the possibility that participants themselves should defray some of the increasing costs that will inevitably result from a real split between industry and medical education. Attorneys and accountants often pay for their own continuing education course work. If lawyers can afford to do it and bean counters can afford to do it, surely doctors can manage too."