What to Do with Big Bad Industry?

WASHINGTON -- Doctors must partake in continuing medical education throughout their careers. That much was agreed upon at a U.S. Senate Special Committee on Aging hearing titled, "Medical Research and Education: Higher Learning or Higher Earning?" But how to fund this education -- specifically whether and the extent to which it should be sponsored by pharmaceutical and device companies -- elicited a broad spectrum of viewpoints from expert witnesses.

Some who testified advocated that industry should play no role in helping doctors continue to develop their skills. Pharmaceutical involvement in continuing medical education, or CME, is estimated to have grown more than 300 percent between 1998 and 2007 to over $1 billion, covering about half of CME services, according to Lewis Morris, chief counsel to the Inspector General of the U.S. Department of Health and Human Services. Some vigorously asserted that such funds substantially influence the curriculum. Others advocated for more stringent rules dictating a "firewall" between pharmaceutical and device companies and CME services. One witness said that industry involvement in medicine -- like funding CME -- has actually spurred medical advances over the past 50 years.

This discussion comes six months after the Physician Payments Sunshine Act -- which requires pharmaceutical and medical device companies to report any monetary transfer to health professionals -- was introduced in Congress. Part of this bill included specific provisions to require university disclosure about funding of continuing medical education. Sen. Herb Kohl (D-Wis.), committee chairman and co-sponsor of the bill, expressed hope that "provisions of our bill will be included in the [Senate] Finance Committee's health care reform proposal" now being drafted.

Although some regulations are in place to limit conflicts of interest, Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic and one of the witnesses, said that those in charge of monitoring industry funds are not doing their jobs. "With the billions of dollars of industry money flowing into CME, who is guarding the integrity of the CME process? Current oversight by the Accreditation Council for Continuing Medical Education is largely ineffective. The ACCME has strict rules governing educational activities, but appears uninterested or incapable of enforcing them."

Murray Kopelow, chief executive of ACCME, told the committee that his organization had considered banning commercial support for CME since 2007, but decided not to do so earlier this year. However, in his testimony, he wrote that because of the spotlight shone on the subject, "the profession (and the Congress) has become fully engaged in a discussion of the future relationship between industry and medical education." ACCME, Kopelow said, is continuing to work towards distancing CME from its corporate sponsorship.

Thomas Stossel, the American Cancer Society Professor of Medicine at Harvard Medical School and founder of the Association of Clinical Researchers and Educators, took a different approach. A longtime supporter of industry presence in medicine, Stossel argued that it's essential to look at the good things that industry-education partnerships have produced. "Almost every reason put forward for how conflict of interest supposedly compromises medical research, especially that it promotes research misconduct, is, when subject to factual analysis, untrue," he said in his testimony. "Similarly, scholarly assessments of the amount of research that moves into product development or of the risks of failure and the costs of that process are inconsistent with critics' claims of exaggerated price gouging."

Some drug and device companies, as mentioned in Kohl's remarks, have begun to their change their policies, including Merck, Eli Lilly and Pfizer. In the audience was an employee of GlaxoSmithKline, which was not commended by Kohl. The employee refused comment to Inside Higher Ed after the hearing.