In this week’s New England Journal of Medicine (subscription required), the office of the Inspector General of Health and Human Services suggests that pooled industry funding for Continuing Medical Education could provide a midterm solution to what the Inspectors hope will be the medical profession’s ultimate decision, to “eschew commercial support for CME.”
Authors Lewis Morris and Julie Taitsman, both counsel to the HHS OIG, ask “what is the best way to ensure that CME serves a bona fide educational purpose, is not co-opted as a marketing tool, and does not violate laws against fraud and abuse?” Their suggestion: a pooled-funding mechanism, whereby drug and device companies would contribute to unrestricted pools of funding controlled by independent grant organizations, who, through a transparent and unbiased process, would “award funding based on the educational merit of the CME programs, without allowing the donors to specify which programs their donations will fund.”
Of course, the authors admit that early signs suggest this is a hard sell to pharmaceutical and medical device companies, whose support for CME has grown 300 percent, and who currently develop and tailor their CME programming to align closely with their product marketing interests. An attempt by the American Academy of Orthopedic Surgeons to create such an independent pool won little company interest.
Still, the authors write, shoring up the independence of CME should be a top concern to the medical profession. “Since the marketing goals of pharmaceutical and device companies can influence CME funding,” they write, “preservation of the academic integrity of CME requires clear boundaries separating education and marketing.”
The HHS Inspector’s office has expressed concern before about the influence of commercial CME funding, and testified in July before a Senate committee on the commercial influence of CME on prescribing and medical practice.
Though the fall of Sen. Byron Dorgan’s drug re-importation bill in the health reform debate earlier this week isn’t news, yesterday’s NPR health blog “Shots” pointed to an analysis of pharma contributions and votes on the re-importation bill by Maplight, a national watchdog group that uses technology to highlight the relationship between financial support and political action. According to the NPR health blog, the Senators “voting nay have averaged 66 percent more in campaign contributions from Big Pharma than senators who voted yea.” Legalizing drug re-importation, which is illegal in the U.S. now, would lower drug costs dramatically – Dorgan estimated $100 billion in consumer savings over the next decade.
Despite the political drama around President Obama’s reversal on the issue of re-importation (he and some Democratic senators took high-visibility stands against the amendment this week, citing issues of drug safety), we hope the commitment the President and these Senators demonstrated to preventing unsafe products from reaching U.S. patients will extend to all the drugs, devices, and ingredients we currently legally import, many coming from countries such as India and China, where regulatory scrutiny is low.
PostScript takes a holiday
Happy tidings, and we’ll see you in 2010!