The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.

Oct. 11, 2009
Oct. 13, 2009
Oct. 15, 2009

Contents:
• Evolution of trauma care in the U.S. should focus on inclusive systems
• Surgeon shortage one area that health care reform should address
• National Safety Council Surgeons’ Award for Service to Safety
• Distinguished Philanthropist Award
• Award-winning geneticist to participate in Surgical Forum
• Young Fellows Association debuts
• Bernard Fisher, MD, FACS, is recipient of 2009 Jacobson Innovation Award
• No easy answers to medical industry support for CME
• Commission on Cancer Paper Competition winners announced
• ACS-Emerson Scholar-in-Residence in Medical Ethics established

No easy answers to industry support for CME

ACS Regent Julie A. Freischlag, MD, FACS, spoke about the Johns Hopkins experience.

The perception of undue influence on physicians from the medical industry has become a troublesome reality that has filtered to industry support for CME programs regionally and nationally.  This growing conundrum was the focus of Tuesday’s 2009 ACS Foundation Medical Industry Breakfast panel presentation on the topic of Medical Support for Continuing Medical Education (CME).

“Questions have arisen relating to the propriety of commercial entities conducting CME programs,” said Ajit K. Sachdeva, MD, FACS, FRCSC, Director of the American College of Surgeons’ Division of Education. “There’s also apprehension about challenges to professionalism posed by real or perceived conflicts of interest.”

He advocated strict enforcement of current standards established by the medical profession and a variety of other regulations to ensure independent and unbiased CME programs. Also, he supported concrete steps by the medical profession to explore alternative funding sources of CME beyond commercial support.

“The transformational change needed in the funding models for CME will require exemplary leadership at all levels and use of a variety of effective strategies,” Dr. Sachdeva said.

In her presentation on the Johns Hopkins experience, ACS Regent Julie A. Freischlag, MD, FACS, said her institution received the grade of “D” for its lack of written policies and procedures related to the medical industry.

“We at Johns Hopkins don’t like Ds,” said Dr. Freischlag, director of the department of surgery at Johns Hopkins Medical Institutions, Baltimore, MD. “With our new policy on interaction with industry, we are now an A in how we are addressing this.”

The Johns Hopkins policy covers everything from forbidding the acceptance of gifts, food, and pharmaceutical samples from industry to allowing industry access to the hospital by invitation only. Johns Hopkins will only accept unrestricted gifts to the university or hospital from industry with no conditions attached. The policy also includes sanctions against these personnel for failure to comply.

“Our goal was to foster a culture in which our staff exercise independent judgment in all their activities and practice evidence-based, cost-effective medical care,” Dr. Freischlag said. “We also want appropriate interactions with industry because they move ideas into development, production and practice for the welfare of patients and the betterment of public health.”

In addressing medical support for CME, Richard B. Reiling, MD, FACS, medical director of Presbyterian Hospital Cancer Center, Charlotte, NC, identified grand rounds, special presentations, and cancer conferences as the primary CME sources for which a community hospital is likely to receive industry support. Community hospitals don’t fund such CME, no matter how beneficial, and will leave that for the physicians to pay themselves.

“If I would put on an adequate program for $90,000 to provide CME for 150 attendees, it will cost a $1,000 a doctor,” Dr. Reiling said. “It’s not going to happen. So where do I get my money? Those of us in private, community hospitals are in real jeopardy. This concern about undue industry influence may be a perception elsewhere, but it’s not a reality here in Charlotte.”

From the perspective of Andy Cron, MBA, vice-president of Cook Medical, the medical device industry has an obligation to educate physicians on a continuing basis about their products, which often change at a pace of every 18 months. The device industry also depends on physician feedback to develop beneficial medical/surgical devices.

“Optimal care of the high-risk patient is highly dependent on technology,” Mr. Cron said. “Innovation is required to improve outcomes, and research innovation and education are linked. Significant and safe innovation by either academia or industry in isolation is not possible.”

In addressing the trends and future of support, Maureen Doyle-Scharff, MBA, senior director of the Medical Education Group, Pfizer Inc, said budgets from pharmaceutical industry for CME programs will continue to shrink. Funding will soon be about performance improvement CME where the program must demonstrate the promise for better educational effectiveness based on the evidence of what works.

“Education for education sake in CME programs will not receive commercial support in the future,” Ms. Doyle-Scharff said. “Education that addresses public health issues and performance/quality gaps will receive a bulk of the CME dollars from industry.”