Healthy Skepticism Library item: 16145

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Publication type: news

Walker EP.
Senate Committee Hears Testimony Blasting Industry Funding for CME
MedPage Today 2009 Jul 29
http://www.medpagetoday.com/PublicHealthPolicy/Ethics/15301

Full text:

A government watchdog and a top cardiologist told a Senate committee today that industry-funded continuing medical education (CME) is tainting the judgment of physicians and driving up the costs of medicine.
The Senate Special Committee on Aging heard from several witnesses who said the line between marketing and education for drugs and devices has been blurred beyond recognition, so that physicians might not even be able to distinguish medical education from a sales pitch.

About half of the nation’s CME is funded by hospitals and medical societies, and the other half is paid for by drug, device, and biologic companies, which have a financial stake in funding physician education about their products and the diseases they treat.

Industry funding for CME has quadrupled in the past decade and now totals more than $1 billion, said Sen. Herb Kohl (D-Wis.), chairman of the committee.

Kohl is co-sponsor, with Sen. Charles Grassley (R-Iowa), of a bill that would require companies to disclose all payments to physicians over $100.

A mechanism should be created to separate the billions of dollars that drug and device companies pay to promote their products from the educational programs that the money pays for, several of the speakers said.

“We need a firewall between marketing and education, and right now they’re blending together,” said Steven Nissen, MD, chairman of cardiovascular medicine at the Cleveland Clinic. Dr. Nissen has been a vocal critic on conflict of interest in medicine.

Although relationships with industry have the potential to expand knowledge and improve care, the influence of commercial sponsors on CME needs to be reduced, said Lewis Morris, chief counsel of the Office of Inspector General in the Department of Health and Human Services (HHS).

Setting up an independent grant-making body that selects which educational projects will receive industry money would put an unbiased middleman between industry and medicine, Morris said.

Several speakers also said that industry-sponsored CME is a major driver of healthcare costs, because pharmaceutical companies are offering education on — and presumably reaping added prescriptions of — pricey drugs, not less expensive generics.

To illustrate, Morris cited a study that found that for every $1 a pharmaceutical company invests in physician events and meetings, including CME, it generates $3.56 in increased revenue.

“I am convinced that the multibillion dollar marketing machine known as CME directly contributes to excess healthcare expenditures,” Dr. Nissen said.

Dr. Nissen said that eliminating all industry sponsorship of CME would be the best way to ensure integrity.

Not all speakers felt the same way, however. Thomas Stossel, MD, a hematologist at Brigham & Women’s Hospital in Boston, said he hasn’t heard any evidence that the current CME system needs to be reformed.

“I see CME as pretty darn effective,” he said, rejecting the idea that a company with a financial stake in a product is automatically a poor provider of education for physicians.

But in April, a report by the Institute of Medicine (IOM) said the medical community should develop a consensus on a new, nonindustry funding source for CME credits. (See IOM Takes Aim at Physician-Industry Ties)

Meetings funded without industry support would surely lack the glitz, fancy posters, and freebies that have come to mark those events, but that’s not what education is about, Dr. Nissen said.

He suggested that drug and device companies could sponsor “marketing junkets” if physicians still longed for all-expenses-paid trips to exotic locales, but that it would be clearly understood that medical education was not part of the equation.

Where would the money to pay for CME come from, then?

Dr. Nissen said that doctors should follow the lead of another high-paid profession — lawyers — and foot the bill for their own continuing education.

James Scully, MD, CEO of the American Psychiatric Association (APA), told the panel that the APA has already decided to phase out industry-sponsored education programs and meals at the association’s scientific meetings. (See Psychiatry Group Plans Phase-Out of Industry-Sponsored Symposia)

The Accreditation Council for Continuing Medical Education (ACCME), the nation’s principle accrediting agency, provides oversight to temper some industry influence on CME, but its role is limited because it does not preapprove CME content or monitor CME programs, said Morris.

A spokesperson for the ACCME told the panel the agency is an effective firewall to protect against industry influence on CME.