CardioBrief

Note to readers: The following editorial by CardioBrief’s Larry Husten appears simultaneously in a slightly different form on KevinMD.Com. CardioBrief thanks Dr. Kevin Pho for the opportunity to bring this piece before a much wider audience.

A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don’t need to be a Washington policy wonk to discover that there’s a huge problem with CME.

Just walk into the lobby of any major downtown hotel when a large medical conference is in town and you will see big cardboard posters advertising “satellite” symposia (“satellite” because they orbit but are not an official part of the main conference). Unless you are a doctor the title of the sessions won’t mean anything to you, and the big, boldface names of doctors featured prominently on the posters will be unfamiliar.

To doctors attending the medical meeting, however, these topics will be relevant to their clinical practice, and the speakers will be rock stars in their field. A top doctor at one of the major medical meetings can make tens of thousands of dollars during the course of a few days at these satellite sessions.

The physicians in the audience receive CME credits, which are necessary for their continuing certification to practice medicine. Somewhere prominent on the poster will be a phrase saying that the symposium is sponsored by a major medical school or hospital. But, in much smaller type at the bottom of the page will be another phrase: “this educational activity is supported by an independent educational grant from” a large pharmaceutical or medical device maker.

Satellite symposia are only the most visible arm of the CME industry. At medical schools and hospitals, in print publications and online, physicians can find endless sources for “free,” industry-supported CME. According to data presented at the Senate hearing, CME is a $2 billion a year industry, and at least half of the funding now comes from commercial sources.

Critics of the system have argued that the educational content is just a cover for the real purpose of these symposia: industry spends more than a billion dollars a year on these programs because they help the companies market their drugs and devices. Defenders of the system say that numerous safeguards put in place in recent years guarantee the independent educational value of the programs.

It will not be easy to simply throw out the current CME system, and there is no current consensus on an alternative system. But most people would probably agree that greater transparency is necessary. This could be achieved, like so much else these days, through an internet website. The site, CME.Gov, would be run by the National Institutes of Health and would serve as a central repository of all significant information for CME programs. It would require all CME supporters, producers, and participants to fully disclose complete information about the funding and the content of their programs. No CME credit could be earned unless all the required information about the CME program were first registered on CME.Gov.

The model for this site is a similar website run by the NIH, ClinicalTrials.Gov, which now carries important information about nearly all clinical trials in medicine. Although it initially met with considerable resistance when first proposed, ClinicalTrials.Gov has now achieved nearly universal acceptance and respect. By providing a high degree of transparency in an extremely contentious area, ClinicalTrials.Gov has helped defuse some (but by no means all) of the more explosive controversies regarding medical research.

It seems clear that any money that goes to medical education should be completely disclosed– by the companies that are the ultimate source of funding, by the medical schools and organizations that provide CME accreditation, by the production companies, and by each and every individual faculty member, with additional reporting of expenses and production fees, including money spent on food, entertainment, and travel. Further, all content from the CME programs– slides, articles, audio/video tapes– should also be fully accessible on the site.

The advantage of CME.Gov is that it would bring much needed transparency and openness to a system that has too often been accused of lurking in the shadows. Transparency is not always a virtue, of course, but when it comes to medical research and medical education it is absolutely indispensable. As Louis Brandeis said, “sunshine is the best disinfectant.”

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