Most of the debate over CME swirls around the estimated $1.1 billion in annual grant funding from pharmaceutical companies. That’s why last week’s GSK announcement that it will issue quarterly reports on educational and charitable grants issued was welcome news to anyone who seeks a bright future for CME.

Starting February 2009, GSK will issue reports on all U.S. grants to health-related organizations. The reports will include grants provided to organizations such as hospitals, teaching institutions, managed care organizations, professional associations, patient advocacy groups, and continuing medical education companies.

In the press release announcing the reports, GSK stated that it provides grants “for programs and organizations that foster increased understanding of scientific, clinical, and healthcare issues, and contribute to the enhancement of patient care.”

Now that GSK, Merck, Pfizer, and Lilly are demonstrating financial transparency, two additional reports will be very helpful in the CME funding debate.

First, the ACCME annual report data showing the total grant funding year-over-year. Usually, the ACCME distributes this information in July, however, the ACCME recently stated that the annual report data “is expected to be issued in mid-September this year.” The ACCME has been, well, busy this year. But at a time when funding is central to the debate and most experts believe we will see that CME grant funding declined significantly between 2006 and 2007, the ACCME needs to match the transparency of the funders.

Once all major grant funders implement a grant transparency and posting system, it will be very interesting to develop a report that calculates the total grant support posted – versus the amount reported in other venues. Perhaps the numbers don’t match? Perhaps small and medium-sized pharma provide more in grant funding than previously projected?

No matter what the financial figures show, sharing them openly will demonstrate that those who make appropriate investments in education have nothing to hide.

We are witnessing a shotgun approach to improving the state of continuing medical education (CME). If we keep it up, the most significant casualty will be the quality of U.S. healthcare.

Consider the load of proposals and actions during the past month:

·      ACCME announced new policies and a program for monitoring and enforcement of compliance with standards and guidelines. The Pulse strongly supports an open process for identifying “bad actors” in CME and dealing with them appropriately.

·      ACCME issued a call for comment regarding proposed policies and a new paradigm for CME management and funding. The difficulty in proposing new paradigms is that we still have yet to define the actual problems we are facing, let alone the terms for the debate. Lots of assumptions and emotion regarding pharmaceutical CME funding, but so little evidence. The smoke remains thick in the air, yet we keep firing off more shots.

·      ACCME released an academic literature survey showing that a relationship between pharmaceutical CME grant funding and bias has not been demonstrated, despite assumptions and accusations in journal and magazine articles

·      Pfizer announced a decision to no longer issue grants directly to one set of accredited CME providers (MedEd Companies), but demonstrated curious logic when company spokespersons said MedEd Company involvement in the development and dissemination of CME content was “critical” for success. Critics of Pfizer’s decision ask “Is this about the quality of the education or the type of organization receiving the check?” A CME leader at another large pharmaceutical company said, “Pfizer’s decision was not evidence-based.” In Pfizer’s defense, CME leader Mike Saxton admitted the decision was partly based on the misperception that accredited MedEd Companies were involved both education and promotion. See the sidebar in the July/August 2008 issue of Medical Meetings.

·      That very misperception was promoted in a poorly researched article printed in BusinessWeek. The reporter, Arlene Weintraub, mistakenly wrote that “marketing firms” were developing certified CME and helping funnel pharmaceutical payments to physicians for biased education (all of which is specifically prohibited). In a field full of educators, the prevalence of misunderstanding about the differences between certified CME and other forms of pharma-funded activities is hard to accept.

·      The ACCME sent inquiry letters to about 100 accredited providers (academic institutions, MedEd companies, and societies) that receive pharmaceutical CME grants. The letters ask the organizations to demonstrate their compliance mechanisms and examples of best practices. An ACCME insider reports that the group expects 90 percent of the providers to demonstrate they are doing the right thing. With help, the remaining 10 percent could identify areas for improvement and change their ways.

·       At the end of July, U.S. Senate staff members met with a few CME professionals, including yours truly. One of the highlights was across-the-board support for continued pharmaceutical and other CME grant funding. Congress apparently doesn’t subscribe to the notion held by some CME sophists that anything funded by pharma is evil. At the heart of the matter is the Senate’s desire to identify “bad actors” in CME and deal with them appropriately. The Pulse supports this continued and enhanced ACCME regulatory role.

The litany of decisions and proposals shows we are trying out multiple approaches. But until we improve transparency related to all of our rules and roles, many of our reactions will remain shots in the dark. And that will further injure our ability to address educational gaps and improve healthcare quality and results.