CME: Points of view	December 2007

Whither CME?

By John Mack
John Mack is the editor and publisher of the monthly e-newsletter Pharma Marketing News

Where do I think the future of continuing medical education is heading? That’s a question that encompasses a lot of territory. Let me start by putting some limits on my soothsaying to areas I know something about: pharma-supported CME and the use of technology in delivering CME. I will further limit my comments to “accredited” CME, such as programs created by providers accredited by the ACCME.

First, let’s look at the trend in pharma support for CME as revealed by data from ACCME. In 2006, commercial support of CME totaled about $1.19 billion ($1.44 billion if you include advertising and exhibits at CME events). That represents about 50% of the total support.

Why won’t physicians pay for CME?

Although $1.2 billion is only a small fraction of the total promotional spend of the industry, a billion here, a billion there, and pretty soon we’re talking about real money! Why should pharma contribute so much for CME in the first place? Doesn’t that naturally lead to biased content? Shouldn’t there be a ban on commercially-funded accredited CME? Why can’t physicians pay for their CME like many other professionals do?

Unfortunately, my guess is that the vast majority of U.S. physicians feel they are entitled to “freebies” from the drug industry, including CME. Free lunches are gone, pens are next; free CME is the last entitlement they have! As long as physicians feel that way, industry funding of CME won’t go away or even diminish. So we will just have to live with it.

What should change, however, is how that funding flows into the CME process. We’ve seen some changes already.

First of all, the growth in pharma-supported CME has slowed considerably since 2003, when new ACCME and OIG guidelines supposedly forced funding decisions to be made outside the marketing departments of pharmaceutical companies.

Yet, it’s unrealistic to expect the drug industry to shell out over $1 billion with no expectation of return on investment (i.e., new scripts for product) and with no involvement by sales and marketing. To suppose, therefore, that all pharma CME funding is handled by medical affairs people without influence from sales and marketing is naive.

Firewall failure forevermore!

Pharmaceutical sponsors are learning how to get around all the firewalls that ACCME has erected between commercial interests and CME content. According to Daniel Carlat, M.D., publisher of The Carlat Psychiatry Report, “[ACCME’s] incremental efforts to create organizational and paperwork firewalls between drug company influence and CME content … has failed.”

Here’s how pharma companies are getting around firewalls.

Medical education and communication companies, a.k.a. MECCs, are responsible for about 40% of all the CME accredited by ACCME. Approximately 76% of the CME delivered by MECCs is commercially funded.

Most MECCs were simply spun off from advertising and marketing agencies doing business with pharmaceutical companies. The new ACCME guidelines, says Carlat, are merely causing these agencies to “spend a lot of money consulting with their attorneys and running Xerox machines to churn out a new layer of paperwork to demonstrate the existence of new firewalls.”

This window dressing is not fooling the Senate Finance Committee, whose investigations may lead to new legislation to limit commercial influence on CME content. This might require commercially-funded CME to have multiple sponsors or for companies to donate money into some kind of blind trust fund.

It would be better, in my humble opinion, to deny accreditation of MECCs that receive financial support from pharmaceutical companies.

Pharma support for schools of medicine

Perhaps medical schools, which provide about 20% of the accredited CME, can take up the slack from banning accreditation to MECCs. There’s plenty of room for growth there. Whereas pharmaceutical companies anted up about $620,000 to support MECC provided CME, they donated only $259,000 in support of CME provided by medical schools. That represents about 62% of the medical school CME income (vs. 76% for MECCs).

A recent study of pharma influence on medical school department chairs, however, suggests that medical schools may be no less biased than MECCs! In that study, approximately 60% of department chairs had some form of financial relationship with the drug industry.

Off with medical school department heads too!

MECCs or med schools – both are tainted. That takes care of about 60% of the CME currently delivered. What about professional societies? These are run by physicians who probably share the same sense of entitlement from the industry as do physicians in general. So, unfortunately, I can’t see unbiased CME from that source either.

Technology’s influence

The only hope may be technology.

I’ve been watching the trend in online CME. The number of physician participants in online CME programs has skyrocketed in recent years. In 2006, there were over 8 million physician participants (obviously some physicians participated in multiple online programs). That represents approximately 26% of physician participants in all methods of CME deliveries. I believe that this trend will continue as more physicians get their CME delivered on demand through iPhones and Blackberries.

My thesis is this: delivering CME via the Internet on demand where and when physicians want it is much more convenient and a lot cheaper than doing live CME events. It may be cheap enough to overcome the physician entitlement problem. In other words, technology may help commoditize CME as it has the news – making it cheap enough to give away or be paid for by physicians themselves. Hey, it could happen!