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.

Oregon Academy of Family Physicians to Industry: Hands Off Our CME!

In the latest sign that physicians are taking control of their own medical education, the Oregon Academy of Family Physicians has announced that they will no longer accept any funding from the pharmaceutical industry. Read an excellent article covering this story in Eugene's newspaper, The Register-Guard, here.

The Academy will be holding its major annual CME meeting May 8-10, and you can read its brochure, along with its statement that it is "100% free of any pharmaceutical funding or support," here.

Congratulations to the Beaver State!

Wall Street Journal Picks up Sloan-Kettering Story

Jacob Goldstein and the Wall Street Journal Blog ran the story on Sloan-Kettering's decision to ban industry funding of CME and generated an entertaining debate in the comments section. I recommend that interested readers take a peek. You'll find the usual polarities in this contentious topic, including both those who cheer on Sloan-Kettering for its ethical stand, and those who warn that this is a dangerous trend and will lead to poorly educated doctors.

But my favorite comment was posted by "Get Real CME Companies," a person who has worked in the CME system for 20 years. The writer's description of how porous the so-called firewall is between drug companies and the "independent" medical education companies that produce the CME is so accurate and trenchant that I can't resist reprinting it below in its entirety:

"I love all the comments by the CME vendors about how great the system is and how the rules require independence. I have never read such a load of crap in my life. Yes, the rules require independence. Who enforces it? If you work in CME you know the answer very well NO ONE. As the recent investigation by the Senate Finance Committee found the ACCME has no teeth whatsover. But more importantly, the rules are loosely structured and basically an entire approach has developed that works around the rules. And it’s not very sophisticated but certainly very devious. Marketing teams will generate a list of medical topics they think are important, things that they supposedly get questions about. Inevitably, certain off-label uses of their product will be on the list because as I said of course they get lots of questions about that. That list of questions or topics will be used by the companies grants department to award grants. Now the CME vendors are very smart folks, it’s an incredibly profitable business. They will submit grants and they will note in the request who the chairperson of the event will be and inevitably it will be the lead investigator from a hot off-label study. It’s a shocker but that grant request will be awarded while hundreds of others will be rejected. So the CME vendors learn over time what exactly they need to do to get the money. Pharma companies don’t need to exercise any control. All the control they need happens right up from when the grant decision is made. It’s a giant game incredibly profitable for pharma and the CME vendors alike. And there is no one minding the store. I have worked in this area for 20 years and what I have seen happen in that time frame makes me sick. CME has become just another marketing tool. Many of the CME vendors are the same companies who do the marketing programs, they just have a CME arm! I applaud Sloan-Kettering. And I applaud this blog for picking it up. I frequently look at about 4 or 5 different pharma related blogs and did not see this anywhere. It’s a great development and I hope it sets a trend. Pharma and CME have had too many years to clean up their act. It’s time for more dramatic change. Please keep focused on this story, it’s huge."

Sloan-Kettering to Commercial CME: "You're Outta Here!"

Memorial Sloan-Kettering Cancer Center, which is ranked the second best cancer center in the nation by U.S. News and World Report, has just achieved another impressive distinction--it has banned commercial funding of CME throughout the institution. In a fascinating article, Dave Kovaleski of Medical Meetings Magazine describes a process that began in July 2006, when the hospital's physician in chief, Robert Wittes, MD, decided to take this bold action in order to keep medical education "purely educational."

This is an instructive case study of how a large institution can wean itself off industry CME support and end up with a stronger educational program. Thomas Fahey, M.D, who chairs the CME committee, has overseen the transition and says that "I don't think there's any evidence to show that the extra money made CME better." In fact, Fahey feels that the new environment "keeps the focus where it should be--on education--and that comes across to participants."

The hospital had received 25% of its CME budget from industry, and in order to make up the shortfall they "de-fancified" their programs. For example, they shifted conferences from hotels to hospital conference rooms, they stopped paying for physicians' lunches, and they recruited more internal faculty members to speak. Apparently, it is still possible to convince physicians to educate their colleagues without the incentive of a fat check. They also increased the fees physicians must pay for some courses by 10-20%.

And what has been the response? Are physicians boycotting these meetings because they are too cheap to pay for their own education, as many defenders of commercial CME warn is inevitable? No. Attendance has remained steady and there have been no complaints.

Obviously, Sloan-Kettering is a particularly well-funded institution, and it can draw on stellar faculty to give CME, both of which make its industry-free transition smoother than it will be for other hospitals. Nonetheless, it provides a encouraging example of what is possible when the leadership decides that it's time do the right thing.