Monday, June 28, 2010

University of Michigan Bans Industry Funded CME

As originally reported in a New York Times article last week, with more coverage today in Med Page Today, the University of Michigan School of Medicine has decided to end all industry support of CME as of January 1, 2011. According to the dean of the medical school, "the decision was based on a review of literature about the influence on clinical faculty of industry-funded CME." Apparently the decision was made after a series of "town hall meetings" at the university and after the Chairs of the academic departments voted to end commercial CME.

We are witnessing a very gradual falling of the dominos, since U Michigan is now the fourth major medical institution in the U.S. to end commercial support of CME. In February of 2008, the Sloan Kettering Memorial Cancer Center in New York gave commercial CME the heave-ho (see my coverage here)
; East Carolina University's Brody School of Medicine is rapidly weaning its CME programs of industry support, to the point where currently only 0.75% of their CME budget is from industry; and Kaiser Permanente's mid-Atlantic region (which covers about 500,000 patients in Maryland, Virginia, and Washington DC) does not accept industry funding of CME. The new information on Brody School of Medicine and Kaiser was shared this past Friday at Pharmed Out's Prescription for Conflict conference at Georgetown University

Meanwhile, Stanford University is trying to distance itself from industry influence on CME, but is having a hard time giving up its addiction to the cash.
While the dean had announced in August of 2008 that Stanford would no longer allow companies to sponsor specific courses, recently the University accepted a $3 million block grant from Pfizer for CME initiatives that would focus in certain specific areas of medicine, areas in which Pfizer markets pharmaceuticals. Presumably, Pfizer will have no influence on the content of the courses, but this is a line we have heard many time before, generally from for-profit Medical Education Communication Companies. Unfortunately, the firewall between the drug companies' promotional agendas and the educators' offerings inevitably thins out, especially when it dawns on the grantees that if the sponsors doesn't like the content of the courses, they'll find someone else to fund the next time granting decisions are made. As if to emphasize this economic reality, the Pfizer grant is actually structured as sequential one million dollar grants to be spread out over three years, presumably with the option of reassessment before the next payment is made. You can read details of the Stanford grant in their proposal to Pfizer here.

Carlat cynicism aside, it is commendable that Michigan has taken this courageous and principled step, and let us hope that other universities take note.


Anonymous said...

Sounds good, but it's more troubling and complicated than it looks, I think. The Last Psychiatrist had an excellent, thought-provoking post on this very topic in 2008.

"Who's going to pay the CME lecturers? Who is going to pick the topics? The government?"

Banning pharma from CMEs sounds great, but it doesn't happen in a vacuum. It creates a vacuum, which doesn't just stay empty. Who fills the vacuum, and with what? Why should we think the replacement will be any better? How will we know if it is any better, two years out? Ten years out?

So many assumptions, so few people asking questions.

Anonymous said...

Who cares if it creates a "vacuum?" Oh so the government doesn't have the money for slanted drug-promoting "CME" propaganda from Big Pharma and we should all jump from the top floors of our Ivory Towers? WTF? (that means Why The Face). Oh, no "research" will be done!!! Intellectual Armageddon is near! Are you kidding? What good is research that is slanted by industry funding? Where does that get us? And where does that get our patients???? Hell, Nissen at the Cleveland Clinic is close to being crucified by GSK for the his work on the vaunted diabetes drug that kills patients!!! I would welcome a vacuum!!!!

SteveM said...

Re: Anonymous - "Who fills the vacuum, and with what?"

I can't understand why you guys create complexity where none exists. This is a simple process problem, not an entangled DSM 5. The obvious working model is the American Bar Association and their CLE courses. They have a central web portal with courses organized by legal domain. It appears that they charge between $100 and $175 per course.

So there you go, let the AMA replicate that. There would be an upfront cost to develop objectively designed courses, but then the revenue stream would be gravy. I mean if you pay a couple of physicians $10,000 to develop a CME course and charge $100 to take it, just 100 viewings would recover the cost. Heck, the AMA could probably license the ABA course management platform with little modification. How hard is that?

One last point about Pharma sponsored CME development. The problem is not sponsorship, its editorial oversight. Well, duh...?

Of course the trivial fix it is to have all CME courses reviewed by unbiased subject matter experts with no conflicts of interest. Whatever contents they deem to be gamed, it's merely sent back for rewrite. Let the professional societies pick the reviews and have the Pharma sponsors pay for the oversight.

Of course the Pharma sponsors would hate that legitimate oversight, which would probably lead to their abandonment of funding and the subsequent evolution to the ABA model. No big deal. Just do it.

Anonymous said...

The article linked below indicates a step in the right direction. The approach to industry-supported CME will also swing back to a more rational one.

Anonymous said...

"Who cares if it creates a "vacuum?" Oh so the government doesn't have the money for slanted drug-promoting "CME" propaganda from Big Pharma and we should all jump from the top floors of our Ivory Towers?"

Take off your tin foil hat for a second and acknowledge that doctors are some of the best educated people known to mankind. They know how to read scientific studies - hell, many know how to produce them. Phama didn't just make up data out of the blue to show that Depakote is good for bipolar maintenance. In fact, if you go read the studies,
Depakote is obviously terrible for just that.

But psychiatrists nevertheless believe[d? one can hope...] that Depakote is the highest standard of care in spite of the evidence, not because of it. They believed the opposite of what any serious inquiry into the published studies would show. So you can say any number of things:
(a) Pharma brainwashed all the doctors;
(b) Doctors are actually idiots despite a decade of higher ed;
(c) Doctors are beleaguered and just don't have the time to read the studies, so they'll believe anything they're told;
(d) etc.

Notice the common factor? I'll give you a hand: it's spelled D-O-C-T-O-R-S. Pharma's not the tumor, removal of which will return us to some mythical state of perfect medicine. The problems are deep, systemic, and complicated. This isn't to deny that there are problems with Pharma. But to use an analogy, if a patient comes in with H1N1 and a compound fracture, you don't give them an antiviral and tell them to drink lots of fluids and check back in a week.

I gather from your highly animated response that you must have interpreted me as saying "Wait, don't stop Pharma-funded CMEs -- think of the children!" The point I was trying to get across is that there are other factors at play and so the game plan needs to look further than simply banning pharma from med schools. (And if they can't fund CMEs but can provide the med school with 10s of millions of dollars for a new building...well...)

Anonymous said...

Hey Anon:
I wear no tin cup. I agree that docs are smart. I am one! Hell, I just read Carlat's blog about UMICH saying that their studies indicated that clinical faculty (aka doctors) were bamboozled by Big Pharam! So put that in your tin cup! I agree with the rest of your post.