AMA: CME Should be Free of Industry Funding

When possible, continuing medical education (CME) should be provided without the financial support of industry or the participation of individuals who have financial interests in the educational subject matter, according to a report on the ethics of industry-supported CME approved by the AMA's House of Delegates at its policymaking meeting in Chicago in June (see What the AMA Recommends on Industry Support of CME).

The report, "Financial Relationships With Industry in Continuing Medical Education," was written by the AMA's Council on Ethical and Judicial Affairs (CEJA).

The report states that CME that is "independent of funding or in-kind support from sources that have financial interests in physicians' recommendations promotes confidence in the independence and integrity of professional education, as does CME in which organizers, teachers, and others involved in educating physicians do not have financial relationships with industry that could influence their participation."

At the same time, the CEJA report acknowledges that industry support is sometimes necessary and recommends that "vigorous efforts will be made to maintain the independence and integrity of educational activities."

The line dividing industry "support" from industry "influence" has been difficult to determine, and a measure of the difficulty is that the CEJA report approved by the delegates was in its fifth iteration, having been reviewed and rejected by delegates in successive meetings of the House of Delegates going back to 2009.

Last year, for instance, delegates sent the report back to CEJA yet again, with many physicians saying that language throughout the report exceeded the jurisdiction of the AMA in governing the behavior of individual physicians and encroached on the territory of organizations and specialty societies, many of which interact with industry to provide CME to their members (Psychiatric News, July 16, 2010).

And though this year's effort was widely regarded as substantially improved, the report still attracted lengthy debate with many physicians—particularly those from surgical and orthopedic groups—saying the language around industry support was still too proscriptive. In fact, the reference committee that heard extensive and divided testimony about the report recommended that it be sent back to the council one more time.

But ultimately delegates approved the report, with many saying that the AMA needed to have policy on this high-profile issue.

William Holt, M.D., speaking for the American College of Surgeons at the house, said the report "still seems to carry a flavor of industry money not being clean no matter how sure you are that industry support doesn't equate to industry influence."

Susan Hubbell, M.D., of the American Academy of Physical Medicine and Rehabilitation, said "the overall tone of the report is that only in certain instances would it be ethical to accept contributions from industry." She added that the Accreditation Council for Continuing Medical Education (ACCME) already has clear guidelines for commercial support of CME.

But Barbara Casey, M.D., of the AMA's Council on Medical Education, spoke in support of the report and said the ACCME accredits providers of CME, not physicians. (The ACCME Web site states that the organization "fulfills its mission through a voluntary self-regulated system for accrediting CME providers and a peer-review process responsive to changes in medical education and the health care delivery system.")

"The report says that when possible CME should be provided without industry support," Casey said. "That's pretty clear. We understand there are instances when it may not be possible not to have financial support, but when it is possible to do without it, that is the high ground."

Susan Gould, M.D., a CEJA member, said the language in the report represents an "aspiration" to achieve, whenever possible, that high ground. "The AMA needs policy on this matter," she said. "We are the leaders in medicine."