Industry-funded CME is a hot topic particular when it’s been found that such funding materially alters the prescribing and dispensing habits of physicians and pharmacists, respectively. There is no doubt that there is a connection between practitioner behavior and industry funding, but is banning industry-funded CME necessarily the way to go? It seems somewhat of an exaggerated reaction to a process that can be managed with some creativity.

The University of Michigan Medical School joins a handful of leading institutions to ban such activities – Sloan Kettering Memorial Cancer Center, East Carolina University’s Brody School of Medicine, and Kaiser Permanente’s mid-Atlantic region. CME, and medical information in general, serves an important economic function. It overcomes (to a degree) market failure in the healthcare sector caused by information asymmetry particularly between the pharmaceutical companies and patients (and practitioners as agents of patients). Given that industry funding is a significant contributor to total CME activities, banning such activities would distort the market. Practitioners (both pharmacists and physicians) would probably spend more time seeking medical information to update their knowledge, would spend more of their resources procuring updated information, and as a consequence would have less time and resources to treat their patients. Alternatively, practitioners may simply not bother updating their knowledge and ultimately compromise quality of care and their patient’s well-being in the process.

So, what are the alternatives? A new model for CME is required – one that permits industry funding and negates its usual effect on practitioner behavior. Following the publication of the Macy Foundation Report (Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning), Stanford University School of Medicine announced its intent to implement a “fundamentally different model of CME”. Stanford does not allow commercial support for a specific subject, speaker, or educational activity and their industry interaction policy speaks to these issues. Stanford’s approach is not an outright ban of industry-funded CME. Instead it aims to balance its internal CME needs through a “metric-based quality improvement and patient safety curriculum” and the industry’s desire to influence practitioner behavior. It’s a tough balance and it’s unclear whether Stanford’s approach will work. It may improve relations with industry or it may motivate industry to work around Stanford and focus its funding on other institutions.

Bioethicists would prefer that Stanford ban industry-funding altogether. Some believe that “private doctors and academic physicians who are paid to speak for drug companies should be barred from presenting educational material at accredited conferences”. Would it make any difference if the presenters were not paid by pharmaceutical companies? It’s still the same information. Or, would it be better if non-healthcare practitioners presented the information for instance, an accountant or lawyer? This way we would have an independent and objective person deliver information they know nothing about. Instead of focusing on who presents the information bioethicists should be concerned with the quality of information presented (methods, outcomes, etc) and on the effects of the information. It makes no difference who presents, but the quality of information certainly matters and so does its effect on patients.

Bibliography

1. Debate Over Industry Role in Educating Doctors
2. Developing More Effective Means of Achieving Improved Performance Among Practicing Physicians through use of metric-based quality improvement focused curricula, pedagogiocal innovation, and simulated and immersive learning.
3. Policy and Guidelines for Interactions between the Stanford University School of Medicine, the Stanford Hospital and Clinics, and Lucile Packard Children’s Hospital with the Pharmaceutical, Biotech, Medical Device, and Hospital and Research Equipment and Supplies Industries (“Industry”)
4. University of Michigan Bans Industry Funded CME
5. ACCME Annual Report Data 2009
6. Continuing Education in the Health Professions: Improving Healthcare through Lifelong Learning