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grantors and providers to discuss trends, has been postponed. Academic medical centers are under similar stress. While less dependent on commercial support than MECCs, industry funding is still a large part of their revenue stream. ACCME 2007 figures suggest a 5% decline in commercial support, and that report covers only the first six months of the academic year.

The 2008 AAMC/SACME Harrison survey mea- sures commercial support during the 2006-2007 aca- demic year and shows 76 medical schools received a total of $144 million. The average school conducts 145 courses that received financial support from in- dustry, and almost all (121) would not have been of- fered had commercial support not been available.

The future Clearly, change is afoot, and it’s not all pleasant. Evo- lution will leave an indelible mark on funding. Phar- maceutical support probably will never be the same, predicts Mark Schaffer, VP for CME compliance at PPS. With their bottom line under attack due to dry pipelines and a host of other reasons, pharma may feature fewer groups addressing independent med ed in the future.“I’m not sure what will happen with CME provider/industry collaboration, because the perception when dealing with a [biopharma-based] marketing or medical group is that you’re still deal- ing with a pharmaceutical company, and I’m not sure that will survive,” says Schaffer. “I don’t think commercial support will go away completely. It will be much less. But even groups like the Josiah Macy Foundation recognized that it cannot be switched off overnight.”

Recommendations from the Macy Foundation, and more recently the Association of American Medical Colleges, have focused on removing po- tential marketing bias from med ed through pooled funding and other means.The perennial debate as to whether CME providers should reduce or eliminate their industry dependence rages on, fueled by new proposals to clean up perceived conflict of interest.

In April, the Institute of Medicine (IOM) intro- duced a report on the subject, noting that industry’s share of funding for medical education has risen from 34-48% in the last 10 years, raising hackles about industry influence. Even as it recognized that commercial funding is needed, the IOM panel chal- lenged societies to come up with guidelines or rec- ommendations on managing conflicts appropriately and recommended creation of a two-year “consen-

CME Timeline

August 2007: ACCME redefines “commercial interest” to require that MECCs separate fully from corporate parents that handle promotion for pharmas.

January 2008: Macy Foundation’s executive summary: “bias, either by appearance or real- ity, has become woven into the very fabric of continuing education,” and calls for an end to commercial support of CME and a new ac- creditation body.

May 2008: AMA’s Council on Ethical and Judicial Affairs issues report essentially calling for an end to commercial support of CME, with only very narrow exceptions.

June 2008: A Pri-Med poll finds 92% of docs disagree with AMA committee’s call for a ban on commercial sponsorship, express- ing concern that it would make CME more expensive and that the quality would decrease.

April 2009: ACCME announces that a ban on commercial spon- sorship of CME is off the table, for now.

May 2009: CEJA and Council on Medical Education issue more reasonable recom- mendations in favor of more stringent guide- lines for “ethically per- missible” acceptance of industry funding.

CME Overview

sus process” for a new paradigm for CME and other industry relationships.

Because those recommendations could resur- face as Obama administration policy—just as IOM recommendations on FDA in 2006 were largely reflected in the initial drafts of the Food and Drug Amendments Act of 2007—some specialty societ- ies, including the American College of Cardiology (ACC), responded swiftly, arguing that in the ab- sence of public funding, industry grants can be sepa- rated from product bias and be firewall-protected to support CME as a means to improve quality of care and outcomes.

“The ACC is very confident that we manage in- dustry funding appropriately, and we are hoping to work with other specialty societies on new codes and guidelines,” said Joseph Green, PhD, SVP of professional development and education and chief learning officer at the ACC.

For their part, all medical schools are either imple- menting or considering industry relations policies. Usually these cover more than just education and conflict of interest. Boston-based Partners Health- care, for instance, in April debuted a policy that in- cludes restrictions on gifts, tighter management of faculty financial interests and oversight of outside activities like consulting, as well as a ban on faculty participation in speakers’ bureaus and ghostwriting.

A major distraction The IOM report was just the latest assault on the way societies and other accredited providers handle commercial funds for medical education. An article published in early April by the Journal of the Ameri- can Medical Association called for medical associa- tions to sever most of that funding, with the excep- tion of journal advertising and exhibit hall fees.

The highly politicized environment, marked by congressional inquiries into industry funding of CME and scrutiny from academic and medical crit- ics, has exacerbated the slowdown and added up to a major distraction for providers. “You’re educating on perception and to people who don’t know what you [as a CME provider] do,” says Seligman. “How perception drives practice is the opposite of what we are trying to achieve, which is practice based on evidence.”

This spring’s decision by the ACCME to nix a proposed ban on industry funding has done little to refocus attention. That’s partly because, while it has tabled the proposal for now, the accreditor reserves

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