Commercial CME loses funding from second drug firm

Following Pfizer's lead, GlaxoSmithKline will direct grants to academia and doctor organizations to avoid bias. Meanwhile, medical education firms defend their work.

By — Posted Oct. 19, 2009

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GlaxoSmithKline plc, the world's No. 2 selling drugmaker, said in September it will stop taking continuing medical education grant applications from medical education and communication companies.

The world's top-selling drugmaker, Pfizer Inc., in July 2008, became the first company to steer its money away from these for-profit CME companies, often called MECCs. Critics argue that commercial CME providers are more likely than nonprofit providers to let bias slip into their offerings.

"A MECC can't say to a drug company grant, 'I can take this or leave this,' whereas a medical center can say that, because they derive income from so many other sources," said Daniel J. Carlat, MD, a prominent critic of industry support for CME and assistant clinical professor of psychiatry at the Tufts University School of Medicine in Massachusetts. "The incentives to create obviously promotional CME are much greater with MECCs than with other organizations."

These kinds of objections helped drive GSK's decision, said Mary Ann Rhyne, a company spokeswoman. "We acknowledge the criticism of medical education and communication companies, and we feel like this is a way that we can take a step to try to address that."

GSK grant applicants will need to identify a clinical gap in care and show how the program will address it while tracking clinical outcomes. "What we hope is that doctors will see educational programs of a very high quality and high relevance to them that they can participate in, knowing that it's not a commercial," Rhyne said.

Last year, orthopedic devicemaker Zimmer Holdings Inc. said it would restrict CME funding to independent third parties, such as physician organizations. After GSK's move, no other firms said they would follow suit.

But GSK's plan seems to reflect a broader trend. Overall industry support for CME dropped 14% to $1 billion in 2008, according to the Accreditation Council for Continuing Medical Education's July annual report. Commercial funding of for-profit CME providers fell at a faster clip of 22%.

Medical education and communication companies said the drug industry's shift to nonprofit providers is based more on bad publicity than the substance of educational offerings.

"This is an environment where people are scrambling to change their policies, trying to pacify their critics, and this is just one of the things they're doing to do that," said Tom Sullivan, president and founder of Rockpointe Corp., a MECC in Columbia, Md. "You can't take this personally."

Sullivan, whose firm owns the ACCME-accredited Potomac Center for Medical Education, said MECCs can be the best source for CME that benefits patients. "The difference between us and a university or a professional association is that it's actually our mission in life to educate physicians. We're not doing 50 other things and 'Oh, by the way, we do that, too.' We're specialists in education."

ACCME Chief Executive Murray Kopelow, MD, said council data don't show commercial CME providers to be less compliant with its standards.

"The actions of GlaxoSmithKline and Pfizer are not based on success or failure in the ACCME accreditation process," Dr. Kopelow said. "The ACCME strongly supports each and every provider type equally and is proud to have each provider type, including medical education companies, as accredited providers."

Adrianne Fugh-Berman, MD, said that even if more drugmakers decide to steer CME dollars to nonprofit organizations, it will do little to reduce biased offerings.

"While programs at academic medical centers certainly have more credibility, they don't have less promotional potential," said Dr. Fugh-Berman, who is principal investigator of PharmedOut, a project funded by a $400,000 grant from the Warner-Lambert settlement over allegations of deceptive off-label marketing of Neurontin. The project aims to persuade physicians to steer clear of drugmaker-provided information about pharmaceuticals.

"Pharma doesn't fund programs that don't help pharma," Dr. Fugh-Berman said.

At the American Medical Association Interim Meeting in November, delegates will consider a report from the Council on Ethical and Judicial Affairs outlining an ethical framework on industry funding of CME.

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CME providers see fortunes fall

Overall industry support for continuing medical education fell 14% to $1 billion in 2008. Commercial funding of for-profit CME providers slipped even more, with a 22% drop. Here is the level of industry support for medical education and communication companies since the ACCME started tracking them in a single category in 2004. Industry funding of for-profit CME providers:

2004 $527.1
2005 $594.9
2006 $620.7
2007 $594.4
2008 $463.4

Source: Accreditation Council for Continuing Medical Education

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