AMA House of Delegates

Thomas Peters, MD, a transplant surgeon and an alternate delegate for the Florida Medical Assn. Photo by Ted Grudzinski / AMA

AMA delegates vote to keep conflicts out of CME

■ Delegates adopt policy on avoiding financial interests with industry and making adequate disclosures.

By Alicia Gallegos — Posted July 4, 2011

Chicago -- Physicians should strive to avoid financial relationships with industry when they are acting as continuing medical education providers, content developers and faculty, according to policy adopted by the AMA House of Delegates.

A Council on Ethical and Judicial Affairs report said that, when possible, CME should be offered without the support or participation of people having monetary interests in the educational subject matter. CME providers and others with roles in CME who might have conflicts should be transparent about those relationships, the report said.

"I was thrilled that the AMA finally was able to take a strong stance on the unethical practice of industry funding of CME," said Daniel J. Carlat, MD, assistant clinical professor of psychiatry at Tufts University School of Medicine in Boston. "This is a watershed moment in the history of medical education, and we will see a vast improvement in the quality and objectivity of CME over the next few years."

The CME and industry issue had come up previously at AMA meetings but the proposals failed to pass.

The new policy allows for some exceptions when CME providers with financial interests participate in CME. However, the report said this should occur only when their roles are "central to the success of the educational activity, the activity meets a demonstrated need in the professional community, and the source, nature and magnitude of the individual's specific financial interest is disclosed."

The policy protects the quality of physician education and ensures that doctors avoid relationships that may undermine the public's trust, said internist Carl Sirio, MD, a member of the AMA Board of Trustees.

"Crafting ethical guidance to accomplish this has been a long process, but we are confident that the policy adopted today helps to preserve the independence and integrity of [CME]," he said. "Its passage underscores the AMA's commitment to patients and to the profession of medicine by ensuring physician education is independent, transparent and in the best interest of patients."

Heated debate on CME

During reference committee testimony on June 19, delegates appeared split over the policy.

Madelyn Butler, MD, an ob-gyn and delegate with the Florida Medical Assn. from Tampa, called the policy "too prescriptive." She said it doesn't reflect the various circumstances that could arise during funding of CME.

The ethical recommendations could harm smaller medical societies that depend on industry for a large portion of CME funding, said Thomas Peters, MD, a transplant surgeon and alternate delegate for the FMA from Jacksonville.

But others, like Lynn Parry, MD, a Denver neurologist and a delegate for the Colorado Medical Society, said the time had come for the report's adoption. "People look to us for guidance. We need to have a clear statement about conflicts of interest, and the time is now."

The AMA report supports existing medical guidelines on CME and puts a greater emphasis on relationship disclosures, while still acknowledging the value of commercial support, said Thomas Sullivan, president of Rockpointe Corp, a Maryland-based medical education company that offers CME courses to physicians and other health care professionals.

"This was a reasonable compromise. ... Their final recommendations are acceptable to all sides of this debate," Sullivan said. "Now that [the CEJA report] is adopted, the debate will change from who supports CME to the value of CME in improving patient care. [At] the end of the day, improving patient health is the goal of all CME providers, educators and participants, and really the only thing that matters."

ADDITIONAL INFORMATION

Meeting notes: Medical ethics

Issue: Patients who provide samples of blood, cells, tissue and DNA may not fully understand that their biological materials may be pooled and stored for future research. Would the development of a universal consent form for research that involves stored biological materials be the best approach to ensure consent?

Proposed action: The Council on Ethical and Judicial Affairs said a universal consent form is not needed, as AMA policy already appropriately addresses informed consent as it relates to biobanking. The council proposed reaffirming several existing policies in reference to this issue. [Adopted]

Issue: Two resolutions asked the AMA to support specific positions on stem cell research and research involving human cloning.

Proposed action: CEJA said existing AMA policy must be updated to reflect the state of research. This means doctors who do stem cell research should adhere to institutional review board requirements. Doctors also should ensure that research is carried out with appropriate oversight and informed consent. [Adopted]

Issue: Studies say terminally ill hospice patients have an extended lifespan and improved quality of life compared with other terminally ill patients. But political discussions and media portrayals depict end-of-life issues in a bad light.

Proposed action: The AMA should meet with stakeholders to lead and direct the national discussion on end-of-life issues. [Adopted]

Issue: A museum exhibit in Michigan showcasing human bodies has raised questions about the cadavers' origins and whether consent was received from their families.

Proposed action: The AMA should request that federal or international authorities investigate if the bodies in the Premier Exhibition Inc.'s Bodies Revealed exhibits were obtained through approved international human rights measures. [Adopted]