Trendspotter: Academia Taking a Stand Against Commercial Influence

Academic institutions that turn away industry money to fund fellowships or continuing medical education (CME) are rare, despite strong evidence that the support of pharmaceutical companies and device makers influences practice patterns. So the stands that the University of Michigan and the University of Wisconsin have taken against these commercial pressures are commendable.

The University of Michigan Medical School recently became the first major medical school to refuse money from drug or device manufacturers for CME presentations. In turning down about $1 million in annual industry support, Dr. James O. Woolliscroft, dean of the medical school, said faculty leaders “wanted education to be free from bias, to be based on the best evidence and a balanced view of the topic under discussion.”

The University of Wisconsin Medical School, unlike most other academic institutions, solicits no funds from device makers for its orthopedic fellowships. Instead, it makes up the difference between Medicare’s subsidy of the fellowships and their total cost by raising funds from non-industry sources.

That few other academic institutions have taken the same stance as the University of Wisconsin is disturbing, considering the conclusion that the Justice Department reached three years ago in an investigation of the device companies’ influence on orthopedic surgeons. The government found that the device makers were bribing the surgeons to use their products in blatant violation of federal anti-kickback laws. The device makers’ bribes and favors included training grants for new orthopedists and consulting contracts for established surgeons, the Justice Department said.

While the device manufacturers pulled back from consulting deals in the wake of this investigation, they continued to funnel money into training programs. According to an Atlantic article by Ford Vox, MD, the industry subsidized the training of up 25 percent of orthopedic fellows in 2010.

Because device makers are interested only in certain specialties, pharma and device industry support of CME - worth about $1.2 billion a year - is of greater concern to those who would like to limit commercial influence on medicine. Every physician must earn a certain number of CME credits each year, depending on which state he or she practices in. So if universities or specialty societies allow speakers to promote commercial products in their educational presentations, those seminars can have a great influence on how doctors perceive those drugs and devices.

The Accreditation Council for CME (ACCME) recently adopted a policy stating that it would no longer grant credits to physicians who attend meetings at which industry employees present research on their companies’ products. Medical education companies, the American Heart Association, and the National Institutes of Health assailed this prohibition, claiming that it would inhibit the dissemination of scientific research. ACCME rejected that charge, noting that its policy applies only to products already on the market. Meanwhile, Dr. Bernard Lo, a leading medical ethicist, said that the ACCME policy didn’t go far enough. Lo maintained that the only way to rid CME of commercial influence is to ban presentations by private doctors and academics who accept industry money.

As anyone who has ever attended a medical conference knows, industry sponsorship of these events is ubiquitous. It could be argued that, unless physicians were willing to pay hefty fees for attending these events, they wouldn’t be held, and doctors would have a harder time learning about the latest medical advances. But online courses, podcasts, Webcasts and other Web-based forms of CME have become widely available, so physicians no longer have to attend live events to get CME.

A few years ago, 70 percent of CME websites were free, which meant that that they probably had some industry support. Most of the other sites charged between $5 and $15 per credit hour. So if a doctor were required to get 50 credit hours of CME annually, he or she would have spent about $500 for unbiased educational content from these sources. It’s unlikely that that amount has risen substantially in the past five years.

A minority of physicians take this route, subscribing to newsletters such as Journal Watch or The Medical Letter that accept no commercial sponsorship or that strictly separate advertising from editorial content. If most doctors were willing to pay a modest sum for their CME, there would probably be a proliferation of subscription-based CME newsletters and Web sites. In that case, there would be far fewer CME conferences, but commercial influence would be greatly reduced.