AMA Delegates Refer CEJA Report on Industry Funding of CME for Further Study

A new report by the AMA Council on Ethical and Judicial Affairs, or CEJA, that aims to guide physician-learners and CME providers in managing their relationships with industry requires further scrutiny, said delegates during the 2009 interim meeting of the AMA House of Delegates in Houston. Delegates subsequently voted to refer the report and its recommendations.

The Nov. 9 decision came as welcome news to the Academy's delegation to the AMA, including AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, who testified during the meeting that the report's recommendations confused issues pertaining to individual physicians with those involving CME providers. Therefore, he said, the report should not be adopted.

According to an executive summary of "Financial Relationships with Industry in Continuing Medical Education," (36-page PDF; About PDFs) the report's objective was "to provide ethical guidance for physicians and the profession with respect to industry support for continuing medical education."

The report's recommendations included considerations intended to "define an ethical framework to guide professional practice with respect to industry support for CME." Among those considerations were

However, the report notes, if adhering to those guidelines "would significantly undermine" physicians' access to appropriate, high-quality professional education, funding or in-kind support may be provided by industry sources under various conditions -- for example, if the CME provider can articulate a compelling reason to accept such support.

In addition, say the recommendations, individuals who have modest financial interests in the educational subject matter may develop content for or teach CME activities on that subject matter if their financial interests are clearly disclosed and if steps are taken to eliminate or mitigate the potential influence of those interests.

Moreover, it can be "ethically justifiable" for an individual who has a "direct, substantial and unavoidable" financial interest in the educational subject matter -- for example, the inventor of a new device -- to develop content for or teach a CME activity as long as certain other conditions are met.

In his remarks to the AMA Reference Committee on Amendments to Constitution and Bylaws on Nov. 8, Epperly said that the CEJA report "confuses the issue of relations between financial supporters of CME and the organizations that are accredited by the ACCME (Accreditation Council for Continuing Medical Education) and comply with its Standards for Commercial Support." (3-page PDF; About PDFs)

"We are all for ethical, transparent and open guidelines that minimize conflict of interests," Epperly told AAFP News Now in a subsequent interview.

However, some of the report's recommendations "step into the relationship between (the pharmaceutical industry) and accrediting organizations unnecessarily," he testified. Other recommendations "appear to properly address the interface between pharma and individual physicians that we believe is the correct purview of CEJA."

"CEJA should address issues of individual behavior. Issues of organizations are addressed by others, including ACCME," Epperly added.

In the end, the reference committee recommended, and delegates agreed, that the report should be referred (9-page PDF; About PDFs) for more consideration.

The committee noted that in testimony, "concerns were expressed that the report does not adequately take into account existing guidelines and does not give sufficient thought to the likely impact of the recommendations, especially on smaller CME providers."

In addition, said committee members, "testimony indicated that the report does not sufficiently distinguish commercial support for organizations that provide CME from physicians' individual relationships with industry."