CEJA to study GME funded by drug, device makers

Dallas -- Physicians at the Council on Ethical and Judicial Affairs open forum held at the AMA Interim Meeting earlier this month were split on whether medical centers should take money from drug and device makers to fund residency slots.

CEJA already was considering whether to tackle the issue of drug and device maker support of continuing medical education when the American Academy of Dermatology in November 2004 announced plans to accept $60,000 from firms such as 3M Pharmaceuticals, Amgen and Wyeth Pharmaceuticals to fund 10 residency slots in dermatology at academic medical centers around the country.

After an outcry from AAD members, in part over the ethical issues involved, the group decided to hold a March 2006 vote on whether to proceed with the plan.

"The problem is that academic research centers have become subsidiaries of the pharmaceutical companies," said Delegate Arthur Gale, MD, an internal medicine physician from St. Louis. "You can see the medical schools need the money. But once they get in, these people start dictating how the money's used. There should be an iron curtain between medical education, research and pharmaceutical money."

Several physicians said that it is difficult to secure a residency in less-profitable specialties, making industry support necessary. Still, they said it would be wise to route the industry money through a foundation or a blind trust to ensure that it didn't have an undue influence on physicians' practices.

"I think it can be done," said Mary E. LaPlante, MD, an alternate delegate for the American College of Obstetricians and Gynecologists. "We need to de-link the money from the donor."

Most of the physicians who spoke at the forum, however, were skeptical of such notions.

"CME is very heavily subsidized by the pharmaceuticals and device manufacturers, and nobody can deny the influence they have," said Mahendr Kochar, MD, a member of the AMA's Council on Medical Education and senior associate dean for graduate medical education at the Medical College of Wisconsin in Milwaukee. "If they started to support GME, the same thing would happen. These companies will influence the faculty and the department in ways that won't be conducive to the education of residents in an impartial manner based on evidence."

The forum next turned to the issue of prioritizing treatments and immunizations during times of crisis. Distribution of vaccines dominated the discussion.

"The problem isn't just deciding who to vaccinate," said Gerald M. Murphy, MD, an alternate delegate and Simi Valley, Calif., ob-gyn. "We're not getting the vaccines."

Instead, Dr. Murphy and several other physicians said, the medicines are distributed at grocery stores and other outlets. "Who gives the physician orders at Costco?" Dr. Murphy asked.

Lastly, CEJA member and Denver internist Mark A. Levine, MD, noted that the AMA doesn't have a policy specifically devoted to the ethical implications of the pursuit of efficiency in health care. "Should we?" he asked.

It depends on how one defines efficiency, many doctors said. "When you figure out that it costs less to do it right the first time," said Daniel H. Johnson Jr., MD, a former AMA president, "then the kind of efficiency you look for becomes apparent."

Others argued that real efficiency meant minimizing patients' wait times for things such as appointments and lab results but maximizing time in the exam room.

Physicians at the CEJA open forum also raised concerns about allegations that cardiologists took kickbacks from heart-device companies to recommend their heart devices to patients.

The open forum issues CEJA chooses to pursue could be studied for as long as 18 months before the council issues a report on the topic to the House of Delegates.