Major Drug Company Alters Policy on CME Payments

Pfizer will no longer directly pay commercial medical education and communication companies (MECCs) to create continuing medical education (CME) programs in the United States, the company announced on July 2.

In a press release, Pfizer said it would eliminate all new educational funding given to MECCs for creating CME programs and would exclusively support institutions and organizations such as academic medical centers, hospitals, medical societies and associations, and universities. These CME providers are ultimately responsible for creating the content of the educational materials and managing potential conflict of interests, although some may partner with MECCs to develop parts of the programs.

This policy change came amid growing criticism from academia and lawmakers over pharmaceutical-company-funded CME and allegations that the scope as well as content of these programs often carries bias in favor of the sponsor (Psychiatric News, April 4).

Continuing medical education has grown into a multibillion-dollar enterprise in the past decade, according to data from the Accreditation Council for Continuing Medical Education (ACCME). In 2006, at least half of all CME activities were funded by commercial support, and MECCs received a larger proportion of industry's educational funding than other types of CME providers. Although industry funding goes to nonprofit as well as for-profit CME providers, it is the commercial MECCs that have drawn most of the criticism for bias.

“Whether it is real or not, we are trying to curb the perception of bias,” Huw Gilbert, a Pfizer spokesperson, told Psychiatric News regarding the rationale for this change. The company will continue to honor existing contracts with MECCs. “We will implement a competitive grant review process for grant applications in order to choose high-quality programs to support,” he said. In 2007, Pfizer gave out approximately $80 million in educational grants.

It remains to be seen whether Pfizer's new policy will be followed by other major drug companies. Eli Lilly, for example, has begun to disclose how it distributes educational grants made since 2007. Pfizer followed suit in May of this year and released names of the recipients of its educational grants in the first quarter of 2008. However, neither company's list, posted online, clearly differentiates recipients between nonprofit entities (e.g., academic medical center, medical societies) and commercial MECCs.

In a set of revised guidelines released on July 10, the Pharmaceutical Research and Manufacturers of America (PhRMA) advised pharmaceutical companies to separate the CME grant-making process from their sales and marketing department and to “ensure that the program funded by the company is a bona fide educational program and that the financial support is not an inducement to prescribe or recommend a particular medicine or course of treatment.” Companies should not “provide meals directly at CME events,” but the CME provider may offer meals to attendees at its own discretion.

The U.S. Senate Special Committee on Aging recently requested information from ACCME including “the accreditation process for CME courses” and “any mechanisms the ACCME has in place to ensure that no undue influence by any industry is being exerted through CME courses.”

Various stakeholders continue to debate whether drug companies' funding or commercial MECCs' direct involvement leads to biased CME programs. Some physicians believe it is a serious concern. In May, the Association of American Medical Colleges endorsed a task force report urging medical schools and academic medical centers to limit industry involvement in CME activities by setting up a central medical education office to receive and coordinate the distribution of industry educational grants. The Council on Ethical and Judicial Affairs of the AMA recently proposed phasing out all industry funding for professional education activities; the proposal drew much discussion at the association's annual meeting in June.

Trade organizations, such as the North American Association of Medical Education and Communication Companies and Coalition for Healthcare Communication, gave their testimonies at the AMA meeting stating that industry funding is beneficial for health care professionals and that the strict accreditation standards imposed by the ACCME are sufficient to prevent conflicts of interest and biased content.

In the end, the AMA House of Delegates voted to send the proposal back to the council for clarification of its recommendations.

Days before the AMA annual meeting, ACCME announced plans to more swiftly discipline CME providers that fail to comply with their accreditation standards and to impose stricter rules governing commercial interests to prevent bias between the funding entity and the CME provider. The accreditation organization has also invited the medical profession, the public, and the CME enterprise to submit comments and debate the future of commercial supports for CME.

Eli Lilly's list of grants is posted at<www.lillygrantoffice.com/grant_registry.jsp>. Pfizer's list is posted at<www.pfizer.com/responsibility/values_commitments/support_medical_patient_organizations.jsp>. ACCME announcement is posted at<www.accme.org/dir_docs/doc_upload/d6b96a50-084c-485b-b71a-6b405b9c07d8_uploaddocument.pdf>. The PhRMA “Codes on Interactions with Healthcare Providers” is posted at<www.phrma.org/files/PhRMA%20Marketing%20Code%202008.pdf>.▪