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CME under scrutiny

Accredited CME is "ineffective" and is used as a vehicle for "aggressive promotion" US senate committee hears

As President Barak Obama's healthcare reform agenda looks to be advancing in the House of Representatives, the pharma industry has come under fire at a senate committee hearing on the potential conflicts of interest of corporate funding of continuing medical education (CME) in the US.

Between 1998 and 2006, the pharmaceutical and medical device industries' funding of accredited CME quadrupled from $302m to $1.2bn, according to the Institute of Medicine. In addition, the pharma industry has increased significantly funding of medical schools and professional medical associations.

Chairman of the US Senate Committee on Aging, Herb Kohl, questioned the motives of the industry at the hearing attended by medical professionals and government health officials.

"Large corporations do not typically spend these sums unless they think they will get something out it," he said. "Are the drug and device industries getting a return on their annual billion-dollar investment in medical education? Do the programmes funded by the industry stay true to their mission of providing unbiased education and research, or do they instead market the industry's latest products?"

"We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered," he added.

Senator Kohl, along with Senator Chuck Grassley, is a co-sponsor of the Physican Payments Sunshine Act, which would require the pharma and medical devices industries to publicly report payments and gifts to doctors. Identical provisions to the Act were included in the healthcare reform discussion documents released by the Senate Finance Committee. In addition, similar provisions were also included in the House tri-committee health reform bill, which includes disclosure of industry payments to medical schools, sponsors of CME programmes and healthcare professional associations.

Speaking at the hearing, Lewis Morris, chief counsel of the Office of Inspector General in the Department of Health and Human Services (HHS), said that pharma companies use their sponsorship of CME to increase market share for their products and profit from their investment. He added that there are examples, unearthed during the department's ongoing assessment of conflicts of interest, that companies have used educational courses to promote off-label use of their drugs.

Echoing Morris' sentiments, Dr Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, told the hearing that he believes CME has become a platform for "the aggressive promotion of drugs and medical devices". Nissen also said that accredited CME should be replaced as a matter of urgency as it is "ineffective".

However, in his speech, Dr Thomas Stossel of Harvard Medical School, said Congress and the public cannot ignore the contribution the industry makes to the scientific understanding of diseases. He said he wants the best information irrespective of who pays for it, adding that non-profit organisations simply cannot get up to speed fast enough to provide the type of education that healthcare professionals require.

Dr Richard Murray, vice president of external medical and scientific affairs at Merck & Co told the committee that Merck was making a major effort to "publicly disclose its financial support to outside groups and individuals who work with the company on initiatives to educate audiences about key healthcare issues aligned with Merck's mission".

He also pointed out that employees responsible for commercialising products at the company are distanced from CME initiatives. "Sales and marketing personnel have no role with respect to CME funding support other than to refer unsolicited requests to our toll-free information line or to our website. We also restrict access to these applications to only our grants professionals who make selections in their sole discretion. We reinforce these procedures through regular, mandated training of our sales and marketing staff to ensure they understand the role Merck can play in CME support and the prohibitions on their involvement in grant application and selection."

Other pharma companies have taken similar public steps to outline their commitment to educating physicians about diseases and medical advances, rather than product promotion, following Pfizer's move in 2008 to withdraw all CME funding made through commercial organisations.

30th July 2009

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