Call for stricter CME gift rules gets mixed reviews

Some in the CME community are concerned that physicians may end up paying for their continuing medical education courses, or see their CME choices shrink dramatically, if a group of 11 physician and academic leaders persuades academic medical centers to adopt tighter controls on gifts from industry.

This group said the medical profession is still too closely tied to the pharmaceutical and medical device industries, and in the Jan. 25 issue of the Journal of the American Medical Association, they called for greater reform.

Harry A. Gallis, MD, president of Alliance for CME said some Alliance members were concerned drug companies would respond to these proposals by taking their marketing dollars out of CME and redirecting them into research or advertising.

"CME grant money may dry up if it gets too regulated," Dr. Gallis said.

The working group, sponsored by the American Board of Internal Medicine Foundation and the Institute on Medicine as a Profession, challenged academic medical centers to take the lead in reform efforts by banning faculty from accepting drug company gifts of any size, drug samples, free meals and free travel to meetings.

In addition, the group recommends academic medical centers funnel commercial CME contributions through a single office at each institution, creating a pool of funds where the school, not the individual companies, determines what CME courses are put together.

Academic faculty members also could no longer participate in drug companies' speakers bureaus. They'd see their consulting and research contracts posted on the Internet, and financial support for general research would go to the institution, not to a specific investigator.

Jordan Cohen, MD, president of the Assn. of American Medical Colleges and a member of the working group behind the recommendations, acknowledged the CME proposal, in particular, could cost the profession.

"I have no doubt there will be a significant reduction in the amount of money from industry for education," Dr. Cohen said. "That underscores why [companies] are giving this money -- so they can influence the profession. If it were a philanthropic effort it wouldn't make a difference."

No free CME?

Critics say putting the kibosh on companies directly funding specific CME courses -- such as diabetes -- could leave physicians with a lot fewer courses to attend.

If companies interested in supporting CME are only allowed to put their dollars into a general fund, no longer earmarking it for a specific course, this would turn industry grants into outright donations, Dr. Gallis said.

"I don't think it would serve the commercials' interest to do too much of that," he said.

Murray Kopelow, MD, chief executive of the Accreditation Council for CME, said the ACCME already tightened its restrictions on commercial CME support less than a year ago.

Dr. Gallis agreed that drug companies have spent a good deal of money complying with Office of Inspector General guidelines by pulling their sales reps out of the CME granting process. Further restrictions could be a major turnoff for the industry because stockholders may look at money spent on donations instead of marketing as a waste, Dr. Gallis said.

Many academic medical centers look for CME departments to generate revenue, educators said, and this revenue comes from commercial grants. If this disappears, they may continue with low-cost activities like grand rounds, which benefit mostly faculty, and forego costlier CME events that tend to serve community physicians.

If industry money is not as plentiful, it also could mean that physicians would have to pay for their own CME. James Naughton, MD, an internist in Pinole, Calif., an ABIM Foundation trustee and one of the physicians on the working group, said he would be willing to bear some of this cost. "I don't think that's unrealistic," he said.

Despite the challenges that a new way of accepting money could create, Dr. Cohen said CME can change.

"There's no reason why the profession should rely on the largess of industry," Dr. Cohen said. "It just isn't right."

The American Medical Association is currently updating its policy on gifts to physicians.