Financial support of continuing medical education.

CONTINUING MEDICAL EDUCATION (CME) IS A MULTIbillion-dollar industry. In 2006, the CME providers accredited by the Accreditation Council for Continuing Medical Education (ACCME) had a total income of $2.38 billion. In 1998, the income was $889 million, and most had come from the registration fees of participants or sponsoring organizations. Since 2003, however, most of the income for CME providers has come from industry. CommercialsupportforCMEaccreditedbytheACCMEquadrupled between 1998 and 2006–from $302 million to $1.2 billion–and doubled from other sources. In 2006, the combined for-profit support (commercial support andadvertising and exhibit income) represented 60.6% of total income. An industry magazine stated in its annual medical education report:“Forcontinuingeducationtocontinue,commercial funding must remain healthy. The future of CME depends on it.” The profit margin for ACCME-accredited providers increased from 5.5% in 1998 to 31.0% in 2006. The 3 main types of CME providers are physician member organizations, publishing and education companies, and medical schools. In 2006, their margins were 46.3%, 34.7%, and 20.7%, respectively. Nonprofit organizations often use CME revenue to subsidize other activities. Continuing medical education has become so heavily dependent on support from pharmaceutical and medical device companies that the medical profession may have lost control over its own continuing education. Commercial funding may inherently distort education and practice to the detriment of physicians and patients, regardless of the various safeguards to protect the integrity of the enterprise. Problems associated with commercial support of CME, current safeguards, and other approaches to funding are discussed below.