Drug firms increased their continuing medical education
(CME) grant activity last year, a sign of faith in what has been a heavily
scrutinized area. But an analysis of spending shows industry is directing more
money into organizations that may appear safer from a public relations
“The trend is still moving toward a direction where people
feel secure in making their investments,” said Marty Cearnal, chief strategy
officer, Jobson Medical Information.
Despite last year's climate of heightened scrutiny,
including a Senate Finance Committee investigation which culminated this year, total commercial support
for CME rose 8% vs. 2005 to nearly $1.2 billion, according to recently released data from the
Accreditation Council for CME (ACCME).
That surprised some observers, who had expected a continued
slowdown in the growth rate, which seemed to hit a rock-bottom 4% in 2005. With
funding from drug firms still hovering at half of total CME revenue of $2.4
billion, the numbers evince an industry that continues to believe in sponsoring
CME after maneuvering to separate grant decision-making from sales and
marketing and taking other compliance steps.
“Some had predicted the demise of CME, because of those regulatory
changes,” said Frank Britt, EVP, Pri-Med. “We're generally very positive about
how the industry is evolving.”
Perhaps more predictable was the direction of funding.
Medical schools and societies saw the highest commercial funding increase of
any of the provider groups, drawing 8% and 7% increases, respectively.
Medical education and communications companies (MECCs) gained 4% more.
According to Cearnal, that reflected grantors' delayed
reaction to the 2003 OIG guidance and other compliance concerns, which was to temporarily
scale back funding as they moved CME authority into the medical department.
Supporters may have emerged from those changes with a more
conservative posture. “[Grantors are] trying to demonstrate their compliance by
getting into a situation where they feel like they're less exposed,” he said.
To be sure, MECCs attracted the most drug company funding of
any provider group by far, about $621 million last year. But the pursuit of what
some see as a safe haven could accelerate even more if another trend started by Eli Lilly
this year—disclosure of educational grants—takes hold throughout the industry.
“If [grantors are] going to publish that information, they would
rather have the names on that list be medical societies, medical schools,
not-for-profit foundations and health organizations, as opposed to for-profit
providers, whether they are accredited providers or non-accredited providers,”
The trend toward safety parallels a focus on efficiency—reaching
more audience members for less money. The most common activity among medical schools
and societies are grand rounds and didactic presentations. These happen to be the
two activities which can expose the most people for the least amount of money.
Research shows didactic lectures have minimal impact on
behavior change, though, and many grantors want to fund quality improvement-oriented
activities, in addition to traditional update-oriented activities. Shifting funding
toward quality programs requires data on which programs are most effective, and
outcomes research is only beginning to tackle this need.
Last year's spending variability also may reflect a quirk in the CME money trail. Those who receive a grant report 100% of it to the ACCME, even if
they partner with another organization on the activity. Transfers from schools
or societies to a MECC are not visible, even if the MECC ultimately
receives a large percentage of the grant. Such transfers, known as joint
sponsorship, are common.
“In the past...a university or a medical school or medical
society that was accrediting the program ...would appoint their MECC partner as
having financial responsibility, and the check would be written to the MECC
because the medical school didn't have the infrastructure to handle the
finances,” Cearnal recalled. “In today's environment, the grantors resist that
kind of behavior, because they want the medical society's or university's names
on a check.”