Drug firms increased their continuing medical education(CME) grant activity last year, a sign of faith in what has been a heavilyscrutinized area. But an analysis of spending shows industry is directing moremoney into organizations that may appear safer from a public relationsstandpoint.

“The trend is still moving toward a direction where peoplefeel secure in making their investments,” said Marty Cearnal, chief strategyofficer, Jobson Medical Information.

Despite last year’s climate of heightened scrutiny,including a Senate Finance Committee investigation which culminated this year, total commercial supportfor CME rose 8% vs. 2005 to nearly $1.2 billion, according to recently released data from theAccreditation Council for CME (ACCME).

That surprised some observers, who had expected a continuedslowdown in the growth rate, which seemed to hit a rock-bottom 4% in 2005. Withfunding from drug firms still hovering at half of total CME revenue of $2.4billion, the numbers evince an industry that continues to believe in sponsoringCME after maneuvering to separate grant decision-making from sales andmarketing and taking other compliance steps.

“Some had predicted the demise of CME, because of those regulatorychanges,” said Frank Britt, EVP, Pri-Med. “We’re generally very positive abouthow the industry is evolving.”

Perhaps more predictable was the direction of funding.Medical schools and societies saw the highest commercial funding increase ofany 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’ delayedreaction to the 2003 OIG guidance and other compliance concerns, which was to temporarilyscale back funding as they moved CME authority into the medical department.

Supporters may have emerged from those changes with a moreconservative posture. “[Grantors are] trying to demonstrate their compliance bygetting into a situation where they feel like they’re less exposed,” he said.

To be sure, MECCs attracted the most drug company funding ofany provider group by far, about $621 million last year. But the pursuit of whatsome see as a safe haven could accelerate even more if another trend started by Eli Lillythis year—disclosure of educational grants—takes hold throughout the industry.

“If [grantors are] going to publish that information, they wouldrather have the names on that list be medical societies, medical schools,not-for-profit foundations and health organizations, as opposed to for-profitproviders, whether they are accredited providers or non-accredited providers,”Cearnal said.

The trend toward safety parallels a focus on efficiency—reachingmore audience members for less money. The most common activity among medical schoolsand societies are grand rounds and didactic presentations. These happen to be thetwo activities which can expose the most people for the least amount of money.

Research shows didactic lectures have minimal impact onbehavior change, though, and many grantors want to fund quality improvement-orientedactivities, in addition to traditional update-oriented activities. Shifting fundingtoward quality programs requires data on which programs are most effective, andoutcomes 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 ifthey partner with another organization on the activity. Transfers from schoolsor societies to a MECC are not visible, even if the MECC ultimatelyreceives a large percentage of the grant. Such transfers, known as jointsponsorship, are common.

“In the past…a university or a medical school or medicalsociety that was accrediting the program …would appoint their MECC partner ashaving financial responsibility, and the check would be written to the MECCbecause the medical school didn’t have the infrastructure to handle thefinances,” Cearnal recalled. “In today’s environment, the grantors resist thatkind of behavior, because they want the medical society’s or university’s nameson a check.”