Elite medical facilities ban commercial support of CME

Stanford University has joined other high-profile medical schools and research institutions in severely restricting funding from pharmaceutical and device companies for continuing medical education programs-including programs for radiologists and radiology technologists.

Under the new Stanford policy, announced in August, all contributions for CME from medical industry will be funneled through a central office. Pharmaceutical or device companies will not be allowed to earmark funds for programs on specific subjects. Commercial support for CME can be provided only in broad areas, such as medical, pediatric, and surgical specialties or diagnostic and imaging technologies. Device or pharmaceutical companies can no longer sponsor exhibits, receptions, briefings, or training sessions in tandem with Stanford CME events.

"We want our educational pro-grams to be primarily science- and evidence-based and free of any commercial bias or influence," said Dr. Phillip Pizzo, dean of the Stanford School of Medicine.

Stanford is one of the nation's leading providers of radiology CME. The department lists 12 multiple-day courses in its 2009 calendar. Its annual international symposium on multi-detector-row CT attracts more than 1000 attendees. The department also sponsors radiology CME conferences on PET/CT and molecular imaging, neuroradiology, sports medicine imaging, and advanced breast imaging and interventions.

The policy may put an end to the sort of elaborate vendor-sponsored receptions that have coincided with the big annual CT symposium. Held in auditorium-sized venues away from the actual conference sites, the events have been notable for full-sized CT scanner ice sculptures, "mad scientist" inspired hors d'oeuvres, and dancers/ acrobats in colorful costumes, futuristic helmets, and roller skates.

The financial impact of the new Stanford CME policy is still unknown, according to Pizzo.

"If company support has been linked either directly or indirectly to marketing goals, I expect that the funding support will decline," he said.

Radiology CME programs that have been planned and underwritten with industry support will be allowed to continue through June 2009.

"Right now we're trying to understand the new guidelines, and we're entering a new phase of analysis," said Susie Spielman, director of strategic initiatives for Stanford.

Her job includes managing Stanford's radiology CME program.

"We're not walking away from our program-but we're working to see what are the best ways to move forward," she said.

The University of California, Davis and medical schools in Colorado, Kansas, Massachusetts, and Pennsylvania have also recently restricted financial support for medical CME from medical device and pharmaceutical companies. These schools have set up a central funding mechanism for CME, but unlike Stanford, they are allowing industry to earmark funds for programs on specific subjects.

Memorial Sloan-Kettering Hospital in New York City has also said it will no longer accept industry support for its CME programs.

But no other medical school has gone as far as Stanford in its approach to CME funding, according to Allan Coukell, director of policy for the Prescription Project, a consumer advocacy group that opposes industry support of CME programs. Funded by the Pew Charitable Trusts, the Boston-based group supports policies aimed at eliminating conflicts of interest between industry and physicians.

"We have a lot of concerns and a lot of evidence that CME can function as veiled advertising. That's why we need to put some firewalls in place," he said.

Industry support for CME came under national scrutiny when a proposed report from the American Medical Association's Council on Ethical and Judicial Affairs in June recommended that individual physicians and educational institutions should no longer accept industry support for professional education. The Association of American Medical Colleges, the organization representing all accredited medical schools, approved a report in June that recommended that all funding for CME should be received and coordinated by a central office at each university.

In a commentary in the Sept. 3 issue of the Journal of the American Medical Association, Dr. Arnold Relman, editor emeritus of The New England Journal of Medicine, called for widespread restrictions on industry support of CME and higher fees for health professionals to protect against commercial biases in their continuing medical education. Salaried faculty at medical schools and universities should be urged to teach in CME programs as part of their jobs.

"Physicians, such as radiologists, are anything but poor, so they should be able to afford to pay for their CME," said Relman in an interview with Diagnostic Imaging.

Policies similar to the one adopted at Stanford, however, are bound to have an effect on the amount of funding their CME programs receive, Relman said. He predicted that industry may withdraw its support of educational programs at Stanford.

"Drug and device companies are not charities. They're not going to justify giving to medical schools without a quid pro quo," he said.

Relman noted that CME funding from industry has long been problematic. With a budget of nearly $3 billion, industry supports more than half of CME programs, he said.

"It's an obvious and inexcusable conflict of interest, and it should be embarrassing to the medical profession," Relman said.

-By Barbara Boughton