The future sponsorship of CME in Canada: Industry, government, physicians or a blend?

A recent editorial in CMAJ1 pointed out that continuing medical education (CME) programs financed by pharmaceutical companies can present information in a biased manner — that, in effect, some of these are thinly disguised efforts to market products. The editorial questioned the roles of professional associations — including the College of Family Physicians of Canada — in providing oversight of CME content offered for educational credit. Certainly, there is evidence that the pharmaceutical industry can influence physician prescribing through marketing and educational efforts.2^,3^,4^,5 In addition, many “unrestricted grants” from commercial sponsors focus on programs that cover an area of practice related to the donor's products, leaving many “orphan” topics that attract no financial support. Yet the fact remains that the pharmaceutical industry in Canada has been a major contributor to innovative, ethically conducted, continuing education programs and health education research. At the CACHE (Canadian Association of Continuing Health Education) meetings in 2002 and 2003, of 155 abstracts that passed a rigorous peer-review process and were accepted for presentation, 63 had authors or coauthors who worked for industry.

Because of the obvious bias that can result when a sponsor chooses the topics for CME and has a hand in writing content, proposals for tightening controls on programs sponsored by industry have been put forward. The US Accreditation Council on Continuing Medical Education — a national agency that accredits CME programs — has floated changes to its guidelines. Under the proposed changes, physicians who have accepted money from the pharmaceutical industry would be banned for life from presenting at accredited CME events. Although others have argued that there are advantages to this proposal,6 if it were put into effect it would empty lecterns and podia across the continent. Industry has recruited many of the best of our teachers and researchers for the development and delivery of their sponsored CME programs.

Sponsorship by industry has come under close scrutiny by government, medical organizations, the media and even industry itself. New proposals to regulate CME could soon become so restrictive as to choke off the financial support provided by industry to assist physicians in attending CME courses.7 The costs of CME are not trivial. Physicians must not only pay for the course and the costs of attending, but must continue to pay office overhead and lose income during their absences. Unlike other professionals, they cannot pass these costs on to their patients in the form of higher fees. If tougher restrictions on financing CME result in reductions (and perhaps even withdrawal) of commercial sponsorship, tuition fees for quality educational offerings will surely increase, adding to the burden on physicians who are trying to maintain their skills.

Some provinces have begun to pay physicians for attending CME programs. This is one solution. A second would be government grants to CME providers to create effective programs at no cost to physicians. A third would be to encourage and create new models whereby unrestricted grants from industry are truly unrestricted.

What are these new models? At the College of Family Physicians of Canada we have separated industry support from CME activities. For example, our Family Medicine Forum receives generous industry support. The CME program, however, is developed entirely by a planning committee with no pharmaceutical representation. Funding is derived from the sale of booths at an adjacent exhibit hall. Attendees have the option of just attending the lectures or of also visiting the companies' booths. Those attending the lectures receive CME credit. In essence, the organizers create a firewall between commercial interests and education, and the registrants benefit from reduced registration fees. There are many examples of pharmaceutical companies working with universities and professional societies to create quality educational programs free from commercial bias. We need to be more vigilant to prevent the few offenders from denigrating all.

The College of Family Physicians of Canada also has a role to play in approving CME courses for credit. Course organizers submit their programs to university CME offices or chapters of the College for review by assigned accreditors. They must submit all materials and answer a series of questions, which includes revealing their sources of commercial support. Once a program is accredited, there is currently no system to audit them as they are being presented. Over the past few months the College has been investigating a system of random audits, including assigned auditors, telephone interviews of attendees and standardized questions concerning commercial bias in post-course evaluations. The College anticipates that the new audit procedures will be implemented as soon as the evaluations are complete. The College of Family Physicians of Canada is in favour of blending these solutions: to pay physicians for lost income, to give government grants to universities and professional associations to create programs, and to continue to support and create cooperative models whereby providers and industry can educate physicians without bias.

𝛃 See related article page 149