IOM probe into conflicts of interest in CME, research ruffles feathers

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Last week's meeting of an Institute of Medicine (IOM) committee gave some hope for a thaw in attitudes toward commercially supported CME, but supporters and providers remain anxious about the group's inquiry into conflicts of interest in medical research and medical education.

“There's a very serious effort to force all commercial support and all of the MECCs out of it,” said Coalition for Healthcare Communication executive director John Kamp. “With the involvement of the IOM, it's no longer just discussion in the halls of academe.”

On March 13, the IOM held the third of six planned meetings on the topic, aimed at producing a report that will “propose principles to inform the design of policies, guidelines and other tools to identify and manage conflicts of interest in these contexts without damaging constructive collaboration with industry.” If conflict hawks like The Josiah Macy Foundation and the Association of American Medical Colleges have their way, what constitutes “constructive collaboration” could be circumscribed dramatically.

Karen Overstreet, president of Indicia Medical Education and past president of the North American Association of Medical Education and Communication Companies (NAAMECC), saw hope for moderation at the March meeting, where she delivered a statement from NAAMECC.

“I think the great majority of participants [in the meeting] came to be in favor of having clinicians disclose their relationships and manage those relationships rather than banning industry relations in total,” said Overstreet, who found a great deal of misunderstanding among attendees. “It was clear that some presenters and committee members don't understand the difference between promotional education and certified CME,” in which physicians can get credit for medical education through an accredited provider.

Industry advocates also argue that the would-be reformers discount the strict guidelines recently imposed on sponsors and providers by the Accreditation Council for Continuing Medical Education (ACCME), which don't address conflict of interest directly but prohibit sponsors from suggesting faculty or reviewing content and require disclosure of any conflicts a speaker might have.
“CME providers are way ahead of the curve in looking at these issues,” said Overstreet.

Tom Sullivan, president of med ed firm Rockpointe, sees election year posturing at play in the inquest. “Some of these people are leveraging themselves into position for the next administration,” said Sullivan. “All these documents they're amassing will be used against us in 2009 for legislation to further restrict industry contacts with doctors.”

The IOM's 17-person Committee on Conflicts of Interest has three more meetings scheduled – on May 21, Aug. 25 and Oct. 16 – after which it will issue recommendations.

The IOM has no policymaking power of its own, but holds tremendous influence with FDA and Congress. The advisory body's recommendations formed the basis for much of last year's FDA Amendments Act, which gave FDA broad new powers to police advertising and post-market drug safety.
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