Industry should stop funding physician education. That message was delivered – again and again yesterday – to the Senate Special Committee on Aging.
Under the chairmanship of Senator Herb Kohl (D-WI), lead co-sponsor of the Physician Payments Sunshine Act, the Committee held its fourth in a series of hearings on financial relationships between doctors and drug/medical device companies.
“Eliminating industry sponsorship is appealing for its purity and simplicity,” said Lewis Morris, chief counsel to the Inspector General of Health and Human Services, enumerating the many problems with industry-funded continuing medical education (CME). However, that won’t happen overnight. In the interim, OIG recommends a number of steps companies should take. One such idea was to establish “pools” of funds overseen by independent boards of experts, although Mr. Morris also noted that this approach had been tried by the American Academy of Orthopedic Surgeons, but not a single company would support it.
Eric Campbell, of Massachusetts General Hospital and a member of the Institute of Medicine Committee on Conflict of Interest, noted that IOM had spent a year looking at all the available data and concluded that CME has become far too dependent on industry funding. “Given the lack of validated and efficient tools for preventing or detecting bias in educational presentations and programs,” Dr. Campbell said that industry funding “creates a substantial risk of bias as education providers seeks to maintain or attract industry support for future programs.”
There were also those advocating continued dependence on industry funding.
Harvard’s Thomas Stossel once again made his argument that new prescription drugs have improved medical care over the past 40 years; therefore, it is beneficial when physicians rely on education paid for by the sellers of those products. It was a logical fallacy that Senator Al Franken (D-MN, and the newest co-sponsor of the Sunshine Act) was quick to point out in the liveliest exchange of the day.
And Murray Kopelow, head of the Accreditation Council for Continuing Medical Education, said that after mulling a stop to accredited industry-supported programs in 2008, the council “would not be taking any action to end the commercial support of accredited [CME],” and defended its continued efforts to clarify independence criteria and firewalls.
But Steven Nissen, a Cleveland Clinic cardiologist and vocal supporter of greater transparency and better drug safety, called the accrediting body “uninterested or incapable” of enforcing its own rules, and called for its end.
“Whatever ACCME is doing is ineffective,” said Dr. Nissen. “We need ACCME to go away and we need to replace it with something else.” He said that third-party companies called medical education communication companies are very much behind the wheel of CME programs that claim support from “unrestricted educational grants,” and that based on the selected topics and speakers, he can nearly always guess the sponsoring company.
The American Medical Student Association’s Jack Rusley also testified, as did James Scully, head of the American Psychiatric Association, which voted earlier this year to eliminate all industry-funded symposia at its annual meeting. Dr. Scully told the committee that foregoing that funding would cost his association about $1.5 million this year, but that it would be worth it in terms of greater public trust.