Michigan med school drops commercial support for CME

The change in policy will mean a loss of $1.2 million for its CME programs, but officials say they are aiming to eliminate bias.

By — Posted July 26, 2010

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The University of Michigan Medical School will become the first medical school to adopt a policy of no longer accepting industry funding for its continuing medical education courses.

It's a decision that came after years of consideration and numerous discussions with faculty and staff, said James O. Woolliscroft, MD, the school's dean. "We think it's very important that there not be a concern or perception that there might be a conflict of interest," he said. The decision is effective in January 2011.

Industry funding currently makes up about 45%, or $1.2 million, of the school's CME budget. "This really requires us to focus on what are we trying to accomplish, how best to enhance learning, and what are the things that are actually critically important to learning," Dr. Woolliscroft said.

Three medical schools -- the University of Missouri-Kansas City School of Medicine, Nova Southeastern University College of Osteopathic Medicine in Florida and Touro University Nevada College of Osteopathic Medicine -- accepted no commercial support for CME in 2009, according to Accreditation Council for Continuing Medical Education records. But none has policies against accepting such support, the schools' spokesmen said.

Of the 2,225 accredited CME providers in the United States, more than 40% take no commercial support for their programs, said Murray Kopelow, MD, ACCME chief executive. Two out of three providers take less than 20% commercial support, and eight out of 10 take less than 50%.

In a June 23 letter announcing the new policy, University of Michigan Medical School officials said CME is part of health care's changing landscape.

"The methods, vehicles, venues and funding models may change, but as an academic medical center, it is our responsibility to hold ourselves accountable and fulfill our educational mission to our physician colleagues' continuing professional development," the letter said.

Ongoing debate

The role companies such as pharmaceutical and medical device manufacturers should play in CME has been a subject of debate for more than 20 years, Dr. Kopelow said.

The ACCME released its Standards for Commercial Support in 1992 and revised them in 2004, requiring CME providers to disclose industry funding sources and design curriculum that is balanced and free of commercial control.

Proponents of commercial funding for CME say such partnerships are a valuable resource, allowing institutions to serve their missions better, reach more people and help physicians stay better informed. Officials at institutions that have chosen to limit or forgo industry funding say their goal is to avoid any semblance of bias.

Thomas Sullivan is president of the Rockpointe Corp., a medical education company that offers CME courses to as many as 40,000 physicians and health care professionals annually. Accreditation standards provide ample protection against industry influence, he said. He pointed to a Cleveland Clinic study published in Academic Medicine in January in which more than 95% of 95,429 physicians said industry-supported CME courses met the ACGME's requirements of being free of commercial bias.

"I felt like it was grandstanding," Sullivan said of the University of Michigan's decision. "We don't really have evidence to show that they needed to make a change."

Cutting commercial support

Memorial Sloan-Kettering Cancer Center in New York City stopped accepting industry funding for CME in January 2007 to ensure balance and as part of a "conscious effort to stop contributing to the excessive costs that the patients have to pay for medications," said Peter Brodhead, the center's administrator of CME.

But it's a formula that wouldn't work for everyone, he said.

Stanford University School of Medicine in California stopped accepting designated commercial CME funding in 2008. Instead, companies can contribute to one of four general categories, said Robert Jackler, MD, the school's associate dean of postgraduate medical education.

School officials found that CME subjects were being selected because of available funding and not for their educational value, Dr. Jackler said. "We sought to find a way of separating commercial support of any influence over design of curriculum."

Commercial funding made up 22% of Stanford's CME funding last fiscal year but now is "minimal," with the exception of a three-year, $3 million grant that Stanford officials received from Pfizer Inc. under the new policy, he said.

Managing interests

Many groups have developed policies on how best to manage commercial interests in medical education. American Medical Association policy states that industry funding for CME is acceptable as long as it doesn't influence course content. The Assn. of American Medical Colleges recommends that institutions establish a central office to handle CME and ensure compliance with ACCME policy.

"We're very strongly supportive of ACCME policy," said Dave Davis, MD, the AAMC's senior director of continuing education and performance improvement.

Bernard Lo, MD, professor of medicine and director of the medical ethics program at the University of California San Francisco School of Medicine, chaired an Institute of Medicine panel on conflicts of interest last year. Beyond CME funding, he said, institutions should focus on CME presenters and whether they have a financial relationship with industry that could pose a conflict.

The University of Michigan Medical School takes pride in being a "national leader on this issue," according to the letter. Specific details of how the new policy will be implemented are being finalized.

It's unclear if other medical schools will follow suit, Dr. Woolliscroft said. "I wouldn't be surprised if this wasn't conversation taking place in many lecture halls."

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ACCME releases guidance on commercial interests in CME

The Accreditation Council for Continuing Medical Education has issued new guidelines to clarify the role of individuals with commercial interests in continuing medical education programs about research.

The ACCME's goal is to "support the free flow of scientific exchange" while protecting against commercial influence, according to a June 28 ACCME statement about the new guidelines.

Recognizing that researchers often have commercial interests, ACCME officials outlined circumstances under which such individuals can plan, speak or give CME presentations.

Industry employees can make CME presentations on content relating to their employer's business lines only if the content is controlled by the CME provider, according to the guidelines.

CME providers should consider whether content includes patient care recommendations, the scientific process is emphasized over products, and scientists are the target audience.

"In making their decisions and determining strategies, providers should always defer to independence and the free flow of information -- and act in the best interest of the public," the guidelines state.

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External links

Accreditation Council for Continuing Medical Education's Standards for Commercial Support (link)

"The Effect of Industry Support on Participants' Perception of Bias in Continuing Medical Education," Academic Medicine, January (link)

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