A series of recommendations released last week by Pew Charitable Trusts’ Pew Prescription Project imply that the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support are not sufficient to ensure transparency in physician/industry relationships or to reduce or manage conflicts of interest in academic medical centers. We asked ACCME President and CEO Murray Kopelow, MD, for his reaction to some of the report’s recommendations.
MeetingsNet: What is your response to the Pew report’s implication that the SCS don't go far enough to ensure fair balance in accredited CME?
Murray Kopelow: It is the professionalism of the CME planners, teachers, and authors—working in the context of the ACCME SCS—that ensures the absence of commercial bias and the fair balance of accredited CME. The successful and widespread adoption and implementation of “ACCME 2004 Standards for Commercial Support: Standards to Ensure Independence in CME Activities” by the ACCME and the CME community is one of the great successes of medical education in the 21st century.
We believe the SCS are the only common set of educational standards shared by multiple professions, specifically medicine, pharmacy, nursing, optometry, dentistry, and physician assistants. They are a fundamental building block of nursing, medicine, and pharmacy’s Joint AccreditationTM—which is the only interprofessional education accreditation system in the world.
MeetingsNet: Are there any of the Pew assertions or recommendations that you believe need clarification?
Kopelow: We welcome—and appreciate—discussions about how accredited CME can best serve the public interest and respond to the evolving healthcare environment.
[However,] we all should be accurate in our claims. For example, the Pew report says, “… central [CME] offices do not prevent companies from specifying the topic of the course or which academic department should receive the funds.” Of course they prevent companies from specifying the topics. ACCME says, “There is no reason for the CME provider to request suggestions for speakers or topics from commercial interests—since it is unacceptable to act upon their suggestions. CME providers can receive commercial support from industry. CME providers cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content.”
Pew also says, “...studies suggest that industry funding of continuing medical education tends to bias topic choices and content in favor of the sponsors’ products and therapeutic areas.” Pew cites studies from 1988, 1992, and 2001. The first ACCME SCS were adopted in 1992. The current version was adopted in 2004. The ACCME commissioned a review of this literature in 2008 looking for the evidence in support of this Pew hypothesis. We could not find it. We do not think it is appropriate to infer that there is research evidence for Pew’s opinions.
We are committed to safeguarding the independence of accredited CME and we take the issues of conflict of interest very seriously, as we have for more than 20 years. As part of that commitment, the ACCME Board of Directors has ongoing discussions about commercial support, conflicts of interest, and physician/industry relationships.
MeetingsNet: Why do you believe that the Standards provide the means to manage potential conflicts of interest?
Kopelow: I think it is important to pause and reflect on the success of the accredited CME community in addressing conflicts of interest and the boundary issues created by the relationships between physicians and industry. Accredited CME providers have more than 20 years of experience managing the boundary issues created by commercial support.
First implemented in 1992, the Standards were updated in 2004. The 2004 Standards were approved by each of the ACCME’s seven member organizations, which represent the profession of medicine and include physician licensing and credentialing bodies.
The Standards have become a national model. The ACCME Standards have been recognized across the health professions. The Accreditation Council for Pharmacy Education has adopted the Standards. In addition, the fields of dentistry, family medicine, nursing, optometry, osteopathy, and physician assistants base their accreditation standards on the Standards.
The federal government recognizes the value of the ACCME Standards in safeguarding independence and the role of accredited CME in supporting public health. The FDA has leveraged the accredited CE system in support of the [Risk Evaluation and Management Strategies] REMS for Extended-Release and Long-Acting Opioid Analgesics. Under this REMS, the FDA is requiring opioid manufacturers to provide grants for CME. This is one example of how commercially supported CME can address a critical public health initiative. In addition, CMS recognized the value of the SCS in safeguarding independence when it exempted accredited CME from its rule regarding physician payments reporting.
The ACCME Standards are recognized nationally, by the profession, by the regulators, and by the government as safeguarding the independence of CME.
It is also important to note that only 18 percent of activities presented by ACCME-accredited providers received commercial support in 2012, according to our annual report. Eighty-two percent of activities did not receive commercial support, accounting for 81 percent of physician participants and 78 percent of nonphysician participants. In 2012, the average percentage of activities presented by medical schools that received commercial support was less than 15 percent.
MeetingsNet: Would ACCME consider adding some of the Pew recommendations to its requirements (i.e., requiring at least two commercial supporters per activity and limiting each to less than 50 percent)?
Kopelow: The ACCME has multiple safeguards in place to ensure that commercially supported and noncommercially supported accredited CME is independent of industry. The ACCME does not accept the premise, advanced by Pew, that commercially supported CME is biased. As such, strategies such as requiring at least two commercial supporters per activity and limiting each to less than 50 percent seem only to increase the complexity and cost of accredited CME.
At this point, the ACCME is focusing on simplifying and evolving the accreditation requirements and process. These goals are the result of our strategic planning and feedback from accredited CME providers and the stakeholder community. We are looking at ways to streamline the requirements and to strengthen support for CME as a strategic asset to healthcare improvement initiatives.
Our position is that the Standards provide a framework for ensuring independence. Within that framework, we allow providers to choose the specific methods for implementing the requirements that work best for them. Certainly, providers could choose to implement those recommendations, but they are not currently ACCME requirements and we do not have plans for incorporating those recommendations into our requirements.