The US Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing on conflicts of interest in medical education. In recent years, the pharmaceutical and medical device industries have increased their funding of Continuing Medical Education (CME), medical schools, and professional medical associations. The industries also pay physicians directly for their service as educational consultants.
According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion between 1998 and 2006.
“Large corporations do not typically spend these sums unless they think they will get something out of it,” said Chairman Kohl. “Are the drug and device industries getting a return on their annual billion dollar investment in medical education? Do the programs funded by industry stay true to their mission of providing unbiased education and research, or do they instead market the industry’s latest products? We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered.”
This influx of funding has raised concerns that CME and other medical educational activities, meant to keep doctors updated on the latest scientific advances and best practices in medicine, could be unduly influenced by the pharmaceutical and device industries. The Aging Committee heard from a number of well-respected witnesses on the topic and considered recommendations for reform of the CME delivery system. The hearing also brought attention to the ways in which some organizations are mitigating industry influence, while also enabling legitimate physician-industry relationships to flourish.
Senator Kohl, along with Senator Chuck Grassley (R-IA), is cosponsor of the Physician Payments Sunshine Act (S. 301), which would require the pharmaceutical and medical device industries to publicly report payments and gifts to doctors. Recently, identical provisions to those in S.301 were included in the health care reform discussion documents released by the Senate Finance Committee. Similar provisions were also included in the House tri-committee health reform bill, which also includes disclosure of industry payments to medical schools, sponsors of continuing medical education programs, and organizations of health care professionals.
The Committee first heard from Lewis Morris, representing the Office of Counsel to the Inspector General in the Department of Health and Human Services (HHS/OIG), who explained their ongoing assessment of conflicts of interest in medical education and outlined potential solutions for reducing the most egregious conflicts without damaging useful and legitimate programs. Next, Dr. Steven Nissen, Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, shared the results of a study published in the Journal of the American Medical Association (JAMA) that revealed the depth of the problem of industry-funded medical education and what steps he believes are necessary to rectify those problems.
Also on the first panel, Dr. Eric Campbell, Associate Professor at Harvard University, discussed the Institute of Medicine’s (IoM) recent study on conflict of interest in medical research, education, and practice. Finally, Jack Rusley, a fourth year medical student and the Chair of the Culture of Medicine at the American Medical Student Association (AMSA) provided information on the AMSA Scorecard and its methodology for ranking medical schools’ policies on transparency in medical education, as well as his personal experience as a student advocate for reform.
On the second panel, Dr. Thomas Stossel, Professor at Harvard University and Director of Translational Medicine at Brigham Women’s Hospital, offered testimony concerning the newly formed Association of Clinical Researchers and Educators (ACRE), which contends that restricting industry funding of education programs would be counterproductive and may ultimately harm both patients and the practice of medicine.
Next, Dr. James Scully, medical director and chief executive officer of the American Psychiatric Association (APA) spoke about the APA’s recently-altered policies and code of conduct on accepting industry funding for educational programs and research and the reasons for those changes. Finally, Dr. Murray Kopelow, President of the Accreditation Council for Continuing Medical Education (ACCME), discussed ACCME’s role in standardizing CME delivery and monitoring potential problems therein.