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
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.