In an effort to "strengthen the firewall" between accredited continuing medical education and pharma promotion, the Accreditation Council for Continuing Medical Education is proposing a policy change that would prohibit corporate logos or mention of specific corporate divisions from appearing in commercial support disclosure statements.
Why consider such a change? Right now, industry logos may occupy a prominent spot on a web page that offers a course and is sponsored by a drugmaker. For instance, take a look at an online course at Medscape called Diagnosis and Treatment of Major Depressive Disorder, which is paid for by Eli Lilly. Some may consider such displays as being too overtly commercial. And so the revised policy would, presumably, minimize such impressions. The ACCME is seeking comment now (see this).
Here is the proposal: "The provider’s acknowledgment of commercial support as required by SCS 6.3 and 6.4 under Standard 6 of the ACCME Standards for Commercial Support must only state the name of the company supplying the commercial support, in text format only. Disclosure cannot contain corporate logos and cannot mention or describe any other units within the commercial interest’s corporate structure" (see this).
Ironically, the proposal may make it harder for doctors to know the extent of industry promotion. As psychiatrist and blogger Danny Carlat points out here, the proposed shift could "undermine" existing standards. In his view, the proposal would actually decrease disclosure, because commercial support disclosures would "get buried in the fine print." After all, a very noticeable logo and disclosure would make it difficult for docs to ignore the sponsor and, perhaps, any possibility of bias.
So we asked ACCME ceo Murray Kopelow for his reaction: "Our motivation is to ensure there’s no corporate presence of industry in CME. We don’t allow logos in educational content; we don’t let it appear on slides or in materials. This proposition was intended to be an extension of that. It's not intended to be less than that...The logo and tag line began to create an appearance of collaborator or co-developer. And ACCME is responding to that...This was an unexpected observation and certainly not what would we want to do…It would not be our intention to create a 'fine-print scenario." He has more to say on this audio.
What do you think?
Should The ACCME Prohibit Disclosure of Corporate Logos and Divisions?
- No (76%, 67 Votes)
- Yes (24%, 24 Votes)
Total Voters: 88
pic thx to tall chris on flickr
13 Comments
Thanks for highlighting this, Ed. Pharma support for physicians' CME is huge and not always apparent.
This is not a big deal. Removing a company's logo will make their support less obvious (and prominent, not more so, as was noted in Ed's piece. Removal of pharma company's financial support for CME *would* be a big deal and would create a very significant vacuum which would be slow to be filled IMO.
Christopher-I believe the issue being raised in this post is that making the support less prominent seems to hide corporate involvement & that the current set-up, where the company logo is used, has the virtue of making the sponsorship obvious.
Salient - thanks. I've rarely resisted the temptation to state the obvious. I think I said what you did, but my broader concern - if that's the proper word - is that pharma support for CME will last only for as long as they can derive some benefit from doing so. If pharma money is withdrawn it will take heroic measures to replace that scale of funding for what is a necesssary professional requirement.
When I see a company name or logo and it says they are sponsors of the educational program, I become very suspect of the presenter. This suspicion increases when the presenter, somewheres in the presentation includes the sponsor product in a very positive way. Even more suspicious when the presenter discusses a use of the drug that has not been approved by the FDA.
Christopher-Couldn't agree more on that point. Companies wouldn't mind discontinuing CME programs entirely if they knew their competitors would do the same thing. They'd be happy to commit those resources elsewhere. The ones losing out would be the physicians, who would now have to pay their own way.
'Though not the same as CME's, medical journals are heavily backed by Big Pharma. One has to weed through the ads to find the medical articles. When I see those ads, I automatically mistrust those same pharmas who are spending billions on direct ads to the public as well. I WANT to know who's buying CME's. Then the doctors can see bias most clearly.
Not that this would necessarily improve their prescribing behavior unfortunately.
Industry-sponsored CME is a boon only to the sponsors (who prop up their marketing messages through presenting their interpretations through an "educational" venue), and to the for-profit CME developers/providers and "Medical Communication Companies."
MDs have many opportunities for "pharma-free CME," Often the quality of these opportunities far exceeds the PhRMA sponsored programs.
Christopher and SP need not worry on behalf of the poor downtrodden MDs who just can't afford the time or financial investment to acquire their own CME. If the CME "junk food" were not avaialable, they would simply shift to the other sources - many of which are already free (through medical schools, Grand Rounds programs, AHECs, etc.). A lot of these are now available via the miracles of the internet to remote participants.
If teachers, realtors, lawyers and any number of other professionals can find the money to pay for their own continuing education, don't you think doctors can too?
This is akin to the "4 hour erection" "warning which is designed to push more Viagra. The Logo should be on every page and take up half of every page and the entire title page.
The literature for Corp sponsored CME should also prominately display the dollar amount given and the products the company makes relative to the CME topic, that way all can see the potential conflict of interest up front.
I dont think the ACCME have been thinking this through. I mean companies do need their logos right? As a Graphic Designer I know the importance of visual marketing. Keep us updated!
Unfortunately, I think that for the most part, those who comment on "subliminal and devious" nature of pharma and their support of physician CME, one might be forgetting that a physician generally has 5-10 years of post graduate training... Pretty smart and intelligent people, I would think. If one under-estimates their intelligence in being able to smell pharma "promotion", what does that say about their decision making ability as doctors? I think anyone who says doctors are hoodwinked, fooled or coerced by pharma as it relates to their prescribing may be unintentionally insulting the smarts of highly trained medical professionals.
As a CME professional, I wanted to chime in - particularly after reading the comments. I have been on the fence about the removal of the logos. I definitely think that having the logo helps the learner see who provided financial support. CME providers are required to provide so much text information that I'm pretty sure most physician learners don't read much, if any, of it. Forcing the disclosure to be text doesn't help the recognition. There are other activities where logos can become more of a promotion element than simple disclosure. I like the Medscape example. It works, though I tend to think the logos are somewhat larger than they need to be. If you noticed, the issue wasn't logo's is was what pharma was including in the logos that made them appear promotional. A better solution might be to rule that the logo may only include a company name and graphic mark - no product or division names.
Many comments mentioned the larger issue of pharma's financial support of CME. Whatever your view - please understand the issue is quite complex - as many of the "pharma free" CME offerings are funded by budgets propped up by pharma funding.
As for bias, if you look at the data (and I wish there was more), there is no one group or type of organization that is less bias than another, simply because of the type of organization.
So, to the point of many of the comments above, the learners are need to have an active role in their continuing professional development - understanding the source of financial support and how that support may or may not influence the content. Making it more difficult to easily determine the source of support does not help.