Life Science Compliance Update

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August 10, 2009

AMA CEJA: Senator Kohl Exerts Pressure for Further Restrictions

With healthcare reform stalled at least until September, the focus on medical organizations is gaining momentum. For example, The Wall Street Journal recently focused on the American Medical Association’s (AMA) yearlong goal of drafting a new ethics policy aimed to limit industry influence on continuing medical education for doctors.

As a result, Senator Herb Kohl (D-WI), sent a letter to the AMA for a status report of how the new legislation was progressing. The chairman of the Aging Committee specifically asked why the CEJA report on medical education was not adopted by the AMA House of Delegates.

Although the Committee acknowledged that there “is a role for valid physician industry relationships,” Senator Kohl still noted the concerns about “real and apparent conflicts of interest associated with these arrangements.” Consequently, he asked about the AMA’s Council on Ethical and Judicial Affairs’ report regarding industry involvement in medical education.

Specifically, he recognized that although CEJA initially addressed in a report that “physicians must not accept industry funding to support professional education activities,” since then that report has been rescinded. The Chairman then asked the AMA to provide a status update as to why this recommendation was removed.

In response, the AMA wrote back saying it is still at work. The organization’s House of Delegates has rejected two proposals, and its ethics committee will take up the issue again in late August, the group said.

The first proposal from the AMA’s ethics committee recommended that doctors and others “must not accept industry funding to support professional education activities.” This proposal focused on the fact that there are not strong enough “mechanisms to manage potential conflicts.” But the impact of waiting until the right guidelines are in place will be detrimental not only to industry, but to patients. Organizations and officials will only use this setback to call for additional regulations, until eventually all of industry is forced to close or invest outside of the U.S.

Drug company funding of CME quadrupled between 1998 and 2006 to $1.2 billion, almost one-half of CME’s total income, according to a 2008 article in the Journal of the American Medical Association. Yet this money represents an extremely small of total healthcare spending. More importantly, the benefit to society for investing in CME is perhaps most valuable to patients and physicians, because it keeps doctors informed, trained, and updated on new technologies, treatments, and medicine.

Furthermore, PhRMA asserted that any efforts to sharply restrict company funding for CME of physicians “could be problematic and could negatively impact public health.” The drug-industry group said that CME is an important tool for updating doctors on the latest medicines, additional indications, and new warnings about drugs and noted that PhRMA has revised its code of conduct to “enhance the independence” of CME.

Ultimately, the AMA needs to take a much more representative voice from the population of physicians, this meaning that instead of relying on the top administrative officials who want to get in the limelight, they need to be more focused on the doctors who treat patients day-to-day, and only have enough time to use medicines and devices that are readily available to them. Often the real conflict of interest is from payer groups (insurance companies, hospitals, and government formularies) which prescribe what drugs or devices a physician uses taking away the physicians’ power to choose what is best for their patients.

Industry brings medical advances directly to patients through their doctors, and there is no conflict in that.

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I am concerned because the insurance companies are discrimminating against elderly by increasing employer share of the premium cost by 50 percent when they reach age 50. Also, insurance coverage is varied for each person and/or family because of the variance in premiums, deductibles and co-pays. It would be fair if premiums were based on a percentage of income and not included deductibles and co-pays.

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