CME providers face stricter financial disclosure

The Accreditation Council for Continuing Medical Education has tightened rules for dealing with conflicts of interest, raising concerns that CME quality could suffer as a result.

Some CME providers say the revised rules will disqualify the best and the brightest from speaking at CME events because of their ties to the pharmaceutical industry. Others worry that the detailed financial disclosure now required will have physicians who participate in planning or presenting CME thinking twice about taking part.

Walter J. McDonald, MD, executive vice president of the Council of Medical Specialty Societies, said its members rely heavily on CME about cutting-edge research, which is often funded by the pharmaceutical industry.

"Doctors want to learn from the ones who are doing the research, who really have the enthusiasm and the most knowledge," Dr. McDonald said.

Revised ACCME standards call for speakers to resolve these conflicts by cutting their financial ties to the pharmaceutical company that funded their work or by presenting their data without discussing clinical implications.

H. Dunbar Hoskins Jr., MD, executive vice president of the American Academy of Ophthalmology, said the ACCME's standards could have the unintended effect of delaying the translation of new developments in ophthalmology into CME.

"Leading experts in ophthalmology often work closely with industry to bring new innovations to patients," he said. "Without this close relationship, we fear innovation and education may proceed at a slower rate."

Dr. McDonald said his discussions with the ACCME suggest that while disclosure alone is no longer sufficient, the speaker could resolve a conflict of interest by making sure that the recommendations being presented are based on the best available evidence, best practice or meta analysis.

"If you have the only evidence, that makes it the best evidence," Dr. McDonald said. "You've reviewed the literature, you've done the work. If it's good research, then you've got hard data to deal with. You are therefore qualified to present it."

ACCME Chief Executive Officer Murray Kopelow, MD, said the council was in the midst of providing further clarification of its standards, and the examples given in its explanatory documents should not be interpreted as the only ways to resolve conflicts of interest.

Primary care responds

Theresa Kanya, vice president of medical knowledge and education for the American College of Physicians, said 29% of CME faculty for the group's 2004 annual meeting reported conflicts of interest. She said it was unclear how many of those conflicts might be irresolvable under the new guidelines.

Much of the education the ACP provides is based on literature reviews and already meets ACCME standards. "I don't want to leave the impression that we will not be challenged with this. Most likely we will have faculty with irresolvable conflicts, but we are optimistic we can manage it," Kanya said.

Alejandro Aparicio, MD, director of continuing physician professional development for the American Medical Association, acknowledged that there was concern within the CME community regarding the impact the updated ACCME standards will have.

"I think that anytime there's something new, it brings a degree of uncertainty for everyone," Dr. Aparicio said. "I think no one can argue with the idea behind it, that we are making sure CME is free of commercial bias."

He said the requirements for increased financial disclosure might not be as sensitive an issue as it has been in the past.

"I think the climate has changed over the years," Dr. Aparicio said. "Ten years ago, this was thought of as a private issue, and now we've come to the realization that we need to be very transparent about our relationships so that learners can rely on unbiased information."

Under the revised standards, speakers, those on CME planning committees and spouses of both must disclose relevant financial relationships, including individually traded stocks.

Robert Addleton, director of education for the Medical Assn. of Georgia, is dreading asking doctors to comply.

"Now you have to ferret out relationships the speaker's spouse may or may not have, besides asking the physicians presenting," Addleton said. "That's not going to go over very well. I'm not relishing asking physicians about that."

While larger CME providers can pay speakers honorariums, which could make compliance with the new guidelines more palatable, smaller hospitals often rely on volunteer faculty for their CME. These doctors might decide that the additional disclosures are too intrusive and no longer participate, providers said.

CME grants move online

At the same time, the pharmaceutical industry is changing the way it funds CME, completely separating their marketing dollars from their education funds.

Now, instead of making a request through a sales representative, local CME organizers are filling out a form online or dealing with an administrator they've never met. Without the help of their local sales representative, staff people at small hospitals might not have the time to pursue grants, reducing the CME the hospital can offer.

The loss of the sales contact also could shrink the pot of money available, according to Van Harrison, PhD, CME director at the University of Michigan Medical School.

"In my opinion, many companies have said the secondary benefit of sales people giving the grants is they get face time with physician leaders," Dr. Harrison said, adding that those companies might now think that their sales staff is losing a secondary benefit and lower how much they spend.

Addleton says CME by community hospitals could suffer from all this change.

"Local CME is one of the few opportunities physicians have anymore to get to know other [area] physicians," he said, a loss not easily duplicated at large specialty meetings.