ACCME: Showing Some Teeth?

This week, the New York Times reported on efforts by the Accreditation Council for Continuing Medical Education (ACCME) to step up its enforcement of its Standards for Commercial Support.  Drug and device companies spent over a billion dollars on accredited continuing medical education (CME) courses in 2008; ACCME’s Standards for Commercial Support are meant to ensure that industry funding does not translate into commercially-biased content.  ACCME’s new focus on enforcement comes in the wake of a Senate Committee on Aging hearing over the summer at which Dr. Steven Nissen of the Cleveland Clinic testified that ACCME should be abolished because it is a toothless watchdog, “uninterested or incapable” of enforcing its Standards.  And that was not the first time ACCME’s oversight of CME has attracted congressional attention.  A 2007 Senate Finance Committee investigation uncovered numerous cases in which drug and device companies violated ACCME’s Standards and expressed concern about ACCME’s years-long delays in imposing penalties for compliance failures.

While noting that medical education is largely self-regulated, Dr. Murray Kopelow, ACCME’s head, told the New York Times that, relative to years past, ACCME was active in 2008 and 2009, investigating twelve complaints and finding five courses to be commercially biased.  In addition, the organization will soon post to its website a list of CME courses and providers found to be biased.  ACCME will also consider a proposal that providers whose courses are found to be commercially biased be required to alert the doctors who attended and provide them with corrective materials.

While these efforts are salutary, an effective enforcement program would require a significant commitment of time and resources (in 2008, there were just under 50,000 accredited CME activities), which ACCME may not have.  Well-known critic of industry-funded CME Daniel Carlat (author of “Dr. Drug Rep,” a fascinating piece about his experience giving paid promotional talks for a drug company) had this  to say about the prospects for effective enforcement:

…if the Atypical Antipsychotic program is bad enough to be pulled for commercial [bias], my conservative estimate is that at least half, probably more, of all industry funded psychiatry CME will also need the retraction treatment. The problem is, who on earth has the time to police these things? Certainly not ACCME. Dr. Carroll and I try to keep on top of the worst of the worst, but we have other things to do in order to make a living. The best and simplest solution would be to end industry funding of medical education altogether.

Seton Hall Law’s Center for Health & Pharmaceutical Law & Policy has recommended just that — that industry funding be ended altogether, on the grounds that drug and device industry funding too often leads to bias and that such bias is incompatible with CME’s educational aims.  Dr. Nissen makes the additional argument that ending bias in CME would reduce inappropriate prescribing of branded prescription drugs, which would in turn yield significant cost savings.  As Dr. Nissen told the Senate Committee on Aging, “That’s one of the ways we can pay for healthcare reform.”