Friday, June 15, 2007

Free CME Without Direct Pharma Support: Is It Possible?

Yesterday, in a post about about pharmaceutical company support of continuing medical education (see "Welcome to the CME Laundromat"), I made a suggestion that, like the rest of us mortals, physicians should pay for their own professional education credits.

This straightforward "solution" to the problem of pharma influence over CME received some attention from other bloggers and their physician audience.

Medical Weblog (Kevin, MD), for example, suggested that "Realistically, if physicians had to pay to attend their own CME lectures, no one would go."

This elicited several comments with different points of view, including the following:
"Realistically, if physicians had to pay to attend their own CME lectures, no one would go."

Speaks for itself, doesn't it?

Wow . . . just wow . . . what a sterling "profession" medicine has become.

Actually, I do pay for my CME, all of it. It just makes me really picky about where I go and what I pay for.

I think if I go to every Grand Rounds at my hospital for a year (which is free) then I can satisfy my CME for the year.

So that is my plan.

Of course, Big Pharma probably pays for half of those speakers, so what can you do.

Demand that hospital officials ban big Pharma from any freebies in the halls of your facility, that's what you can do. Big Pharma's influence over physicians is equivalent to lobbyists' influence over elected officials.

My father was in politics and told me "politicians are like women who walk the streets and do favors for money."

I swore off all "free" CME 4 years ago and only use CME that I pay for, on the grounds that he who pays the fiddler calls the tune and any "free" stuff in the end is nothing but progaganda. I must be some kind of freak because I payed for about 70 hours of category 1 last year. Mostly though puchased audio programs which is much cheaper than traveling to a meeting so I am still ahead.

If we are not adult enough to take responsibility for our own professional development-and to pay for our own pads and pens--then we have no right to expect autonomy as an independent profession.
These responses belie the contention that if docs had to pay for CME, none would go.

BTW, there are several options for delivering CME -- including via the Internet -- which do not require that physicians "go" anywhere except to their home computers or local medical school or hospital. If they attend their professional organization's meetings, they can get CME while there. All these options involve little out-of-pocket travel expense specifically for CME.
Note that ACCME guidelines for commercial support of CME states that "CME providers may not use commercial support to pay for travel, lodging, honoraria, or personal expenses for non-teacher or nonauthor participants of a CME activity."
Whatever the solution, pharma has to get out of paying directly for CME content, even if such support is regulated and at arms length (ie, out of the hands of sales and marketing departments).

Free CME Without Direct Pharma Support
Pharma can still support CME through advertising and exhibits at events that host CME. Right now, only about 11% of CME expenses are paid for through advertising and exhibits (see chart). That may be because most of pharma's CME budget is allocated to creating the content, not advertising and exhibits. If the first option were not available, I am sure the second option would receive much more attention and dollars.

Aside from live CME events, pharma advertising can help support free CME through other delivery channels such as TV and the Internet.

Free CME TV?
Why not have free CME TV for physicians just like we have free soap opera and reality TV for the masses? I note that four of the world's biggest pharmaceutical companies are proposing to launch a television station in Europe to tell the public about their drugs (see "Pharma Shopping Channel?"). If they can do that, they can also do CME TV.

Why not an all-CME TV network? Like the Weather Channel?

Of course, I am only half serious about this, but it is worth thinking about to overcome the challenges.

One challenge is to deliver the CME and doctor ads ONLY to physicians, otherwise all the advertising would have to follow direct-to-consumer (DTC) regulations set by the FDA. As we all know, such advertising is not very educational. Doctor ads need to be more like detail aids than 60-second DTC ads.

Therefore, to do free CME on TV, you would need some kind of closed-circuit channel, an idea that was tried before and failed, which is not to say that it cannot be tried again.

But delivery of video via the Internet is now possible and quite popular. And the Internet offers all the necessary security and verification to assure that only qualified physicians will have access.

Whatever the delivery channel, keep in mind thatdvertising can corrupt editorial content as well (eg, advertisers can pull the $ from online CME events they don't like). That's another challenge Free CME would have to overcome.

Anyway, just some food for thought, which I hope generates some comments.

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