Life Science Compliance Update

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October 06, 2009

AAFP Policies on Industry Relations Well Established - Well Managed


The American Academy of Family Physicians (AAFP) recently addressed some of the reports and opinion pieces that call on medical professionals to keep their distance from pharmaceutical companies in terms of industry support  in an editorial titled: AAFP Policies on Industry Relations Well Established, Well Managed


Particularly for Continuing Medical Education (CME) the AAFP specifically addressed:


· The so-called Macy Report (243-pages);

· A one page report from the AMA's Council on Ethical and Judicial Affairs;

· A special communication in the Journal of the American Medical Association; and

· A 360-page report from the Institute of Medicine addressing "conflicts of interest in medical research, education and practice," all lead members to ask, "What is the position of the AAFP regarding interactions with pharmaceutical companies?"


The problems with these reports and opinions, according to the AAFP, are that they “start from a basic premise that any engagement with the pharmaceutical industry is a conflict and must be eliminated.”


Contrary to this belief, the AAFP does not accept this "good money/bad money" hypothesis, and neither do most professional associations because “pharmaceutical and other companies have a significant role to play in informing health care professionals about the availability and proper use of medications and other therapies.”


As “the nation's first recognized accreditor of CME the AAFP has an established membership and renewal criteria requiring accredited CME. In addition, “the AAFP has consistently demonstrated its dedication to supporting physicians in their obligation to learn and advance scientific knowledge by engaging in lifelong learning.” Consequently, after years of such experience, the AAFP, as do many professional associations know that “that potential conflicts of interest and relations with industry can and must be managed consistently and effectively.


Particularly, the AAFP feels that physicians and physicians-in-training have the responsibility to be trained in the appropriate use of medicine and devices when “industry's products are based on solid medical science and best clinical practices.” In order to manage these responsibilities, the AAFP has many policies in place to manage relationships between CME providers and funders, beginning with full disclosure. In fact, the Academy makes sure to prevent any potential conflict between content and funding and to resolve conflicts as needed.


As a result of such prevention for over 60 years, a study performed by the Accreditation Council for Continuing Medical Education, or ACCME, in 2007 demonstrated that there is no difference in the level of bias between pharmaceutical company-funded CME and nonfunded CME, as long as the CME is accredited according to the ACCME Standards for Commercial Support. Ways that the AAFP ensures transparency include:


· Training staff members to make sure conflict of interest forms for leaders and CME are standardized, consistent and clearly understood;


· Enhancing its faculty database reporting and searching functionality to prepare for organization-level reporting of faculty with industry relationships;


· Involving faculty and staff members in the AAFP CME educational National Faculty Education Initiative program offered by the Alliance for CME and the Society for Academic CME that clarifies the differences between promotional and educational activities; and


· Pursuing ways of incorporating patient, practice and clinical data into the needs assessment and outcome evaluation of AAFP-produced CME.


The AAFP also noted that it “does receive funds from pharmaceutical companies for an array of activities, from advertising in its journals to exhibits at the annual Scientific Assembly to grants for CME." According to AAFP, since these two categories do not apply, the AAFP's level of pharmaceutical industry funding is 11 percent, which is well below the "acceptable threshold" of 25 percent proposed by the authors of the JAMA article.


With over 94,000 members, the Academy, along with many other professional associations have a high degree of confidence in the ability doctors to know right from wrong and to refuse to let their professional judgment be influenced by trivial contacts that some individuals and government types now seek to criminalize. Trusting your doctor to make the best decisions for patients means getting the continuing medical education they need to stay up to date with new breakthroughs, research, clinical studies, medicine and devices.


As many CME supporters continue to ask: if industry support is lost or reduced, who will pay for continuing medical education?


The AAFP asserts that physicians will have to pay for CME if industry funding is removed. This is already a problem because doctors who need the education and individual learners or organizations, such as the AAFP, already pay more than 50 percent of CME costs. Without CME support, the “burden will shift even more” causing “added stress on family physicians in clinical practice” who cannot financially afford such programs.


If CME is less available to practicing physicians and more funds are shifted to promotional spending, such as direct-to-consumer ads, patients and providers will both suffer. Doctors need CME to learn about the medicines and treatments they use with their patients so they are prepared to effectively diseases they will encounter.


By taking a leading step in supporting industry-physician relationships, the AAFP has given a clear message that patients should support: the need for CME is only growing with the discovery of new treatments and medicines, and family physicians consider commercial support of CME a vital part in delivering quality patient care.

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