Nissen: ACCME should be abolished

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The Accreditation Council for Continuing Medical Education (ACCME) is a toothless watchdog and should be abolished, said Cleveland Clinic's Dr. Steven Nissen at a Senate Committee on Aging hearing.

The accrediting body is “uninterested or incapable” of enforcing its own rules, said Nissen, who groused that he had written letters to ACCME complaining of bias in continuing education but hadn't received so much as an acknowledgment.

“Whatever ACCME is doing is ineffective,” said Nissen. “We need ACCME to go away and we need to replace it with something else.” He said industry-funded CME is a huge driver of healthcare costs, estimating that the government could save $900 billion over 10 years on unnecessary prescribing of branded drugs — in part through curbing bias in continuing education. "That's one of the ways we can pay for healthcare reform," said Nissen.

ACCME chief Dr. Murray Kopelow defended his organization at the hearing, detailing tougher guidelines that the group has instituted in recent months and saying that the lax practices described by critics “is in another time and another place.” But conflict-of-interest hawks far outnumbered defenders of the CME profession, and the event had the feel of a pile-on, as speaker after speaker painted a bleak picture of a CME enterprise that comingles marketing and education, and senators questioned the value of commercial support. What's the worth of industry-sponsored CME “other than a nicer hotel and shrimp?,” asked Sen. Al Franken (D-MN).

Lew Morris, general counsel at the Department of Health and Human Services' Office of the Inspector General, suggested that eliminating commercial support altogether was “appealing for its purity and simplicity,” and said drug and device companies must separate grant-writing functions from sales and marketing and eliminate any control over speakers and content — seemingly oblivious to the fact that they have already done so. Eric Campbell, of Harvard Medical School and the Institute of Medicine conflict of interest committee, said “the current system of funding is unacceptable and should not continue.”

The hearing opened with a statement from committee chair Sen. Herb Kohl (D-WI), who scolded the AMA for failing to update its conflict of interest policy regarding CME and said “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.”

Other speakers included Jack Rusley of the American Medical Student Association, Dr. James Scully of the American Psychiatric Association and Dr. Thomas Stossel of Harvard and the Association of Clinical Researchers and Educators, a newly formed pro-CME industry group.

“If there is a crisis in continuing medical education today, it's the alarming drop in public and private investment in quality medical education," said John Kamp, executive director of the Coalition for Healthcare Communication, in a statement. "Our conversations with independent education providers from all sectors indicate that commercial support for CME has dropped 20 percent this year alone. Further decreases in CME funding would be harmful both to physicians and the patients they serve. In the midst of the health care reform debate, let's not be distracted by creating yet another possible cure for potential [conflicts of interest] when real people with real medical needs are our biggest challenge.”

PhRMA noted in a statement that its member companies recently adopted new conflict of interest guidelines. "To safeguard against even the perception of a conflict of interest, medical societies and others already have drafted robust codes of conduct. PhRMA recently updated its ‘Code on Interactions With Healthcare Professionals,' making several changes designed to enhance the independence of CME," said the statment. "Among these new provisions, the PhRMA Code states that funding for CME should support a full range of treatment options and not promote a particular product; companies should separate CME grant-making decisions from sales and marketing departments; and companies should follow CME accreditation standards and respect the independent judgment of CME providers. There is no evidence that a company's funding of CME or other physician educational activities, when provided within appropriate guidelines, creates bias."
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