Policy and Medicine

ACCME Supported Study Shows No Evidence to End Commercial Support

Where is the Beef?

This is the question that was answered by a study commissioned by the Accreditation Council for Continuing Medical Education (ACCME): The Relationship between Commercial Support and Bias in Continuing Medical Education Activities: A Review of the Literature to determine if there is bias in commercially supported CME and what does that mean for patient care.

The study was conducted by:

Researchers in the Department of Lifelong Education, Administration, and Policy at The University of Georgia.

The answer was a resounding We have no evidence here to support the claims that that industry support of CME produces bias and that patients are in any way harmed.

METHODS

We searched Medline, LexisNexis, and Business Source Complete databases with very general terms of “education” and “industry or commercial” and “influence or support”. Our literature search identified more than 2,000 article titles. We then narrowed down the search to “continuing medical education” to reduce to 165 articles. These articles then were sorted into evidence-based studies and commentaries or conceptual articles on the topic. We ended with 10 evidence-based articles that addressed the relationship between commercial support and CME, which are listed in Table 1 and annotated in the Appendix.

RESULTS

We found no studies that directly addressed the question of whether commercial support produces bias in accredited CME activities. The 10 studies were then grouped into three categories: 1) four studies that examined the impact of commercially supported CME on prescribing practices, 2) four studies that examined physician opinions about bias in commercially supported CME, and 3) two studies about instruments to measure bias in commercially supported CME.

They recommended additional research:

It is necessary at this time to initiate rigorous scientific studies to address important questions about the relationship between commercial support and bias in CME. The research could focus on several questions:

• Does commercial support produce bias in CME activities?

• What are the mechanisms by which bias is produced?

• Are accreditation guidelines or other strategies effective in preventing bias?

• In what ways does commercial support of CME contribute to physicians’ adoption of the sponsor’s product in the context of the other influences on their clinical decision-making?

• As a result of commercially-supported CME, does physicians’ adoption of the sponsor’s product lead to better patient care?

Doing more research will answer these questions in time.

Groups like the AMA CEJA, Institute of Medicine and others should take a step back and consider what would be the benefit of changing a system of education without evidence that the change will benefit patients.

The Relationship between Commercial

Support and Bias in Continuing Medical Education Activities: A Review of the Literature

Pfizer Publishes Grants

Pfizer published a list of grants that were given in first quarter 08, this included all charitable and educational grants. 

They had announced in March in a letter to Senator Grassley that this was a work in process.  This is a growing trend in our industry started by Eli Lilly and is being considered by most of the major pharmaceutical companies. 

“We want to bring greater transparency to the way we partner with leading medical, scientific and patient organizations,” said Jeffrey B. Kindler, Chairman and Chief Executive Officer of Pfizer. “Detailing these grants and charitable contributions is an important part of our ongoing transparency drive.”

From first reading of the grants and recipients, these disclosures show just how committed companies are to helping society and include grants for Aids projects in Africa, Malaria Patient Education and Treatment, and a large initiative (approximately 1/3^rd of Grant funds) by the California Academy of Family Physicians and others on reducing smoking to improve public health.

If we disclose, perhaps the outside world will better understand the value of what is being done to educate healthcare providers and others and the value to the medical and patient community.  Click the link for a full listing of recipients and accompanying press release .

Open for Interpretation (ACCME Post March Board Notes)

The ACCME on April 17^th posted ACCME summary of March 08 board of directors meeting. 

Key Points:

A)     Expanding office (adding more office space)

B)      Has plenty of money ($5,000,000 in net assets)

C)      They are expanding their education initiatives to include physicians and other healthcare providers

D)     The board met with the Chief Council of the US HHS Office of Inspector General, and an assistant councilor (wouldn't it be interesting to know what they learned).

E)      Offered that the board agreed “that under some circumstances, organizations that are currently exempted from being considered an ACCME-defined commercial interest could become one when they own all or part of an entity that is aligned in partnership with a firm taking an FDA-regulated product to market. 

a.       This may mean that additional provider types (Hospitals, Universities, and Medical Societies) may in the future come under the same rules as medical communications companies and have to adopt firewall policies that are submitted and acceptable to the ACCME.  (See Ask ACCME Standards for Commercial Support 1: Independence)

b.      This was in response to a December 17, 2007 meeting by NAMMECC and the Coalition for Healthcare Communications with the ACCME senior leadership.