Industry support of CME--are we at the tipping point?

n engl j med 366;12 nejm.org march 22, 2012 1069 action led physicians’ organiza­ tions and the pharmaceutical in­ dustry to adopt increasingly re­ strictive codes of conduct related to industry support of continuing medical education (CME). The Ac­ creditation Council for Continu­ ing Medical Education (ACCME), which accredits CME providers, progressively developed an aggres­ sive system of identifying, disclos­ ing, and resolving conflicts of interest. Despite these increasing restric­ tions, industry support for CME grew substantially between 1998 and 2007, from $301 million to $1.2 billion per year (see graph).1 By 2007, industry support account­ ed for 48% of the revenue of ac­ credited CME providers (not in­ cluding advertising and exhibit payments, which accounted for an additional 11% of total reve­ nue). In the past few years, how­ ever, the tides have started to shift. Commercial support for CME started to decline in 2008, and by 2010 it was down 31% from its peak 3 years earlier. Over a similar period, a series of influential reports and policy pa­ pers have recommended major new restrictions on industry fund­ ing, with some proposing the complete elimination of industry support for CME.2-4 Several aca­ demic medical centers have adopt­ ed stringent restrictions on con­ flicts of interest for speakers and in some cases required that in­ dustry funds be directed to a cen­ tral funding pool divorced from individual programs. Other insti­ tutions have gone further and completely prohibited industry support of their CME programs. Twenty percent of accredited CME providers and 80% of accredited CME activities (including grand rounds programs) did not receive any commercial support in 2010.5 New rules under “sunshine” pro­ visions of the 2010 health care reform legislation may require ex­ tensive disclosure reporting for speakers and learners in commer­ cially supported CME activities, creating an additional roadblock for industry support. Perhaps most strikingly of all, the House of Delegates of the American Medical Association (AMA) recently approved an opin­ ion from the AMA Council on Ethical and Judicial Affairs that “when possible,” CME activities should be developed without in­ dustry support and without the participation of teachers or pro­ gram planners who have financial interests in the subject matter. The new policy defines circum­ stances that allow continued in­ dustry support and the involve­ ment of conflicted experts. It was passed only after more restrictive language that was present in four previous, unsuccessful proposals had been watered down. None­ theless, this policy is important Industry Support of CME — Are We at the Tipping Point?