School restricts industry funding of CME courses

Philip Pizzo

The School of Medicine will no longer accept support from pharmaceutical or device companies for specific programs in continuing medical education, as industry-directed funding may compromise the integrity of education programs for physicians, officials said.

The action on CME builds on a 2006 policy that banned gifts, including free meals, and industry marketing at the medical center.

Stanford is one of the few U.S. medical schools to enact such restrictions, which took effect Sept. 1. The policy is being implemented as part of the school's ongoing review, begun in 2005, of its interactions with industry in the educational and clinical arenas.

Continuing medical education programs are designed to help physicians stay current in their fields and are a legal requirement for physcians to remain licensed to practice medicine. Under the new guidelines, the school may accept commercial support for CME only if it is provided for broad areas, such as medical, pediatric and surgical specialties; diagnostic and imaging technologies; and health policy and disease prevention. Funding must not be linked to a specific course, topic or program. In addition, commercial exhibits will no longer be permitted at Stanford-sponsored CME activities on or off campus.

In announcing the latest decision, Dean Philip Pizzo, MD, said he believes CME programs can be true to the School of Medicine's goal of improving quality and clinical outcomes only if they are free of commercial influence.

'I want to be able to honor the public trust,' Pizzo said. 'We want CME to be unbiased and science-driven, and we don't want it to be influenced by marketing. We want our educational activities for whomever we are serving - whether it's our own faculty or our colleagues in the community, locally or globally - to be true to the science and the evidence, and not be influenced by any kind of financial industry support.'

In recent years, the pharmaceutical and medical-device industries have been a growing source of funding for CME programs. Between 1998 and 2006, industry funding for CME activities nationwide rose from $302 million to $1.2 billion, according to the Accreditation Council for Continuing Medical Education.

Some find this to be a worrisome trend. In June, the American Medical Association's Council on Ethical and Judicial Affairs issued a report urging individual doctors and medical institutions not to accept industry support for CME, saying it could 'threaten the integrity of medicine's educational function.' A conference of medical professionals convened in 2007 by the Josiah Macy, Jr. Foundation similarly concluded that because of industry's involvement in CME activities, 'Bias, either by appearance or reality, has become woven into the very fabric of continuing education' for physicians. Industry funding of CME activities also has been called into question by Congress, with two Senate committees reviewing the issue.

Robert Jackler

'Under the present system, in many circumstances a CME course will be held only if a commercial company is willing to sponsor it,'' said Robert Jackler, MD, the medical school's associate dean for CME. 'While for-profit enterprises may occasionally engage in philanthropy, it should not be surprising that the core motivation of pharmaceutical and medical-device industries in supporting CME is to market their products and services.

'This leads to a CME curriculum which is, at least in part, designed to address market needs rather than being entirely focused upon improving performance of practicing physicians,' added Jackler, who is also the Edward C. and Amy H. Sewall Professor in Otorhinolaryngology and chair of otolaryngology. 'Clearly it would be preferable for Stanford faculty to design our CME curriculum solely based upon the needs of our learners as they seek to address the health-care needs of their patients.'

Stanford's medical school first took up the issue in 2007, when Pizzo appointed a 16-member task force, comprised of a diverse group of faculty and staff, to consider future options for CME. In fiscal 2006-07, about 38 percent of the school's budget for CME, or $1.87 million, came from industry sources. Task force members gathered detailed financial data, reviewed the literature, interviewed industry representatives and engaged in spirited debates.

'We all agreed it is inappropriate for industry to influence content,' said Harry Greenberg, MD, the school's senior associate dean for research and chair of the CME task force. He said the group sought to determine whether companies who wished to provide CME funding could do so without controlling the content.

'If industry really wants to enhance the education of clinicians, they should be given the opportunity to do so,' Greenberg said. 'But we wanted to create a situation in which they had no effect on the choice of topics or their content. So we're happy to have industry support as long as it is provided without expectations about the course content.'

Any funds received will be channeled through the school's CME office, which will work with the faculty to determine how best to use the money to meet the needs of physician-learners. The new process 'really brings control of CME curricula back to academic medical centers,' Greenberg said.

Harry Greenberg

Jackler said the decision will dramatically change the way the medical school conducts its CME programs. Rather than organizing symposia at hotels or resorts, he said Stanford's offerings, which draw physicians from around the world, will try to make use of campus facilities.

He said the school may seek funds from private foundations to help support the new CME approach.

The medical school also plans to modernize the format of future programs, relying less upon traditional lectures and making greater use of innovative educational technologies. These include Stanford's well-known programs in simulated and immersive learning, as well as other technologies that will become available with the opening of the Li Ka Shing Center for Learning and Knowledge in 2010. The new CME program also will place greater emphasis on identifying interventions that promote quality care and health-outcomes improvements as opposed to the more traditional CME focus on knowledge acquisition.

Pizzo said he hopes Stanford's new approach to physician education will serve as a model for other medical schools around the country.

'I think right now industry is under a lot of pressure in its use of marketing for education. They're re-examining their role in CME as well,' Pizzo said. 'As we take this step, my hope is that other institutions will start to follow suit. I think the climate will change dramatically to enforce that. If institutions do not take greater responsibility, there is going to be a mandate, whether it's one that we initiate or one that is imposed, that frees up these intertwined interactions of academia and industry around medical education.'