ACCME proposals imperil CME, critics say

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As ACCME's public comment period on a proposed restructuring of the CME funding structure drew to a close, industry groups blasted the accrediting body for what they see as an overreaction imperiling medical education.

In June, the Accreditation Council for Continuing Medical Education (ACCME) announced a public comment period, running through September 12, aimed at stimulating a debate on the merits of commercial support of CME and how conflicts of interest might best be minimized. ACCME kicked off the festivities by reiterating its desire that “due consideration be given to the elimination of commercial support” and proposing a “new paradigm” in which commercial support would have to pass a four-part test, ensuring that:
•    “Educational needs are identified and verified by organizations that do not receive commercial support and are free of financial relationships with industry” such as government agencies;
•    “CME addresses a professional practice gap of a particular group of learners corroborated by bona fide performance measurements” like the National Quality Forum;
•    “Content is from a continuing education curriculum specified by a bona fide organization” including medical societies and medical boards;
•    “CME is verified as free of commercial bias.”

Alternately, ACCME suggested a system of industry-donated, pooled funds.

The North American Association of Medical Education and Communication Companies called ACCME's objectives laudable but said eliminating commercial support “may well cripple the ongoing viability of the CME enterprise” and called its “new paradigm” “ambiguous and unworkable and, in any event, beyond the ACCME's authority,” suggesting that the organization's Standards for Commercial Support adequately address concerns about bias and that problems should be addressed through more aggressive monitoring and enforcement by ACCME.

The Washington Legal Foundation said the ACCME's proposed policies “raise serious First Amendment concerns” and that “basic notions of due process require the ACCME to give a better account of its intent and why its proposed changes are justified.”

The Coalition for Healthcare Communication suggested that ACCME is punting on its responsibilities. “ACCME is facing a credibility crisis with its traditional stakeholders -- organized medicine, academic leaders, specialty societies and accredited providers -- as well as new players including public policy makers such as Sens. Grassley and Kohl,” said Coalition executive director John Kamp. “All these and law enforcement officials are challenging ACCME's credibility, processes and effectiveness. To retain the moral, political and educational high ground, ACCME must recognize that it is a public institution engaged in preserving the public trust. Among other things, it must immediately apply basic principles of fundamental fairness and due process to its policy making and enforcement actions. If ACCME does not quickly accept its public trust responsibilities and adopt serious reforms, organized medicine, industry and providers will be forced to begin serious discussions about the creation of a successor organization.”

In a September 15 editorial, Journal of the American College of Cardiology editor in chief Anthony DeMaria, MD, expressed concern about AMA and ACCME proposals to eliminate commercial support, which he views as “throwing the baby out with the bath water.” DeMaria noted that much has changed since he started out in medicine three decades ago, when “the interaction between industry and physicians was primarily promotional and solicitous,” and worried that “it is not clear how or if the financial support for CME provided by industry could be replaced.”

Moreover, said DeMaria: “Inherent in such an action is the idea that physicians are like sheep: easily led and without the ability to recognize biased or slanted information. I find this demeaning to the profession.”

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