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AAO's stand on the Standards

Many thanks to a kind reader who forwarded the full text of the AAO press release. In case you also have trouble accessing the site, here it is:

Academy Expresses Concern With Revised ACCME Standards for Commercial Support of CME Activities

October 8, 2004

SAN FRANCISCO The American Academy of Ophthalmology has requested that the Council of Medical Specialty Societies (CMSS) investigate an interpretation of new rules regarding conflict of interest and continuing medical education activities.

At issue is the Accreditation Council for Continuing Medical Education s revised Standards for Commercial Support of CME Activities, which was approved by the CMSS and other ACCME parent organizations on September 28th. Although the new Standards were reviewed by the Academy and other specialty societies, the ACCME issued them with a number of explanatory documents which were not reviewed or approved. The explanatory document entitled, Implementing the 2004 Updated ACCME Standards for Commercial Support precludes anyone with a financial relationship with any commercial interest in a health-related company from controlling the content of a CME activity.

When the ACCME initially issued a draft version in 2003 the Academy and many other CME providers vigorously protested, saying it would severely devalue the quality of their educational efforts. Revised Standards for Commercial Support were presented to the parent organizations, and the CMSS approved those revisions because they required that accredited providers identify and resolve conflicts of interest, but did not exclude committee members, teachers and authors with financial relationships from planning or leading a CME activity.

Among other things, the new interpretation as expressed in the explanatory document fails to recognize the realities of continuing medical education, said Academy Executive Vice President H. Dunbar Hoskins Jr., M.D., noting that the leading experts in ophthalmology often work closely with industry to bring new innovations to patients. Without this close relationship, we fear innovation and education may proceed at a slower rate. While we applaud the goal of removing commercial bias from medical education, we believe this is over reactive.

The Academy is also concerned that limiting what physicians can say in a continuing medical education class is antithetical to the free flow of ideas and vigorous debate. We believed the final revision would allow faculty and authors with financial relationships to lead CME activities as long as they disclosed their relationships, because disclosure would constitute a resolution of a conflict of interest, said Richard Zorab, the Academy vice president of Ophthalmic Knowledge. However, according to explanatory documents posted on ACCME s Web site, the call for a more fair and practical rule has gone unheard, said Zorab. The ACCME s interpretation continues to maintain that disclosure of financial relationships is insufficient to resolve a conflict of interest. This interpretation was written by ACCME staff, and not reviewed by the parent organizations.

The explanatory document does provide two ways to resolve the conflict: alter the financial relationship or alter the individual s control over content.

These alternatives are unacceptable, says Dr. Hoskins. We cannot and should not ask our faculty to alter their financial relationships. Moreover, he stressed, The idea that anyone with any type of relationship with a commercial interest is automatically tainted is simply wrong.

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