Continuing medical education is a legal requirement for doctors in every state so they can keep abreast of new developments in medicine. CME has become a huge profit center for some companies and a vehicle for drug and medical device companies to sell their products. 

Continuing medical education “has become an insidious vehicle for aggressive promotion of drugs and medical devices.”

These are not my words, but the words of Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. He has also said: “CME has largely evolved into marketing, cleverly disguised as education.”

In the event you are not familiar with the Cleveland Clinic, it is one of the leading medical institutions in the United States. It ranks with the Mayo Clinic.

Continuing medical education is a legal requirement for doctors in every state so they can keep abreast of new developments in medicine. CME has become a huge profit center for some companies and a vehicle for drug and medical device companies to sell their products.  

Dr. Nissen was testifying before the United States Senate Committee on Aging  when he spoke these words. He also said that the U.S. spends, on a per capita basis, $90 billion a year more than other industrialized countries on health, largely as a result of prescribing habits promoted by doctor education activities. If those costs were eliminated, it could fund a major portion of health care reform, he said.

Drug companies spend $1 billion per year on doctor education. 

In March of this year, Massachusetts implemented regulations banning pharmaceutical and medical device companies from providing gifts to physicians, limiting when companies can pay for doctors’ meals, and requiring companies to publicly disclose payments to doctors over $50 for certain types of consulting and speaking engagements. Only two other states have any kind of regulation of such activities. 

Continuing medical education is very important. Doctors should be required to obtain continuing education to keep up to date on the most recent advances in medicine. I am sure that many doctors obtain more education than is legally required.  Most lawyers do. 

However, there is an inherent conflict of interest when drug companies and medical device companies pay for the education.  Dr. Daniel J. Carlat, a professor at Tufts University School of Medicine, testified before the Senate Special Committee on Aging this summer that he had given dozens of talks for the manufacturer of Effexor, an antidepressant, to primary care physicians. He was paid more than $30,000 in 2002 by the manufacturer, Wyeth. Dr. Carlat admitted that “under the watchful gazes of Wyeth drug reps,” he “artfully emphasized the positive data about Effexor and glossed over data regarding potentially dangerous side effects, such as high blood pressure.”

I mentioned above that the drug companies spend a billion dollars a year on such education. This is a reduction from $1.2 billion from the previous year and only after pressure from physician groups and Congress. 

Where does this money go? Most of it goes to private companies, called medical education communication companies, which are often affiliated with marketing and advertising firms. These companies actively solicit drug companies to create accredited educational programs who have a captive audience with physicians who must have continuing education under state laws. 

There is a national organization that supposedly oversees these programs and makes sure that there is no direct communication between the drug companies paying for the program and the person preparing the course materials.  However, this “firewall” is not very effective.

According to Dr. Carlat’s Senate testimony, Pfizer gave more than $12 million for a series of CME courses about smoking cessation, and one of the major recommendations of the course materials was to use Pfizer’s anti-smoking drug; but the course materials omitted any of the drug’s dangerous side effects. 

Dr. Carlat has made several recommendations. First, he said that all drug companies should be required to disclose all funding for accredited continuing education programs, which includes the name of the program, the nature of the program, the names of all organizations and people participating in the preparation of course materials, and the specific amounts of money paid to each person involved in the program. 

Dr. Carlat also recommended that the Physicians Payment Sunshine Act should be adopted, which would institute national reporting requirements so that patients will be able to learn whether their doctors are receiving payments from drug companies. These payments may not be unethical or inappropriate, but when drug companies pay physicians for purely marketing activities, a potentially dangerous conflict of interest could arise. 

Payments to physicians could provide an incentive to the doctor to exaggerate the benefits of a product when they discuss it with other doctor or with their patients. 

As health care reform is being debated in Congress in the coming days, it will be interesting to see if any of the reforms include this topic. Dr. Nissen, the chief cardiologist at the Cleveland Clinic, concluded his remarks before Congress with the following statement: “As a nation, we spend nearly double the expenditures of other industrialized countries on health care. We use more expensive medical drugs and medical devices than other countries, even when adjusted for our national wealth. I am convinced that the multibillion dollar marketing machine known as CME (continuing medical education) contributes to this excess in healthcare expenditures.” 

What do you think the chances of health care reform including any consideration of this topic? Check the contributions by the political action committees to our elected representatives and I think you will find the answer to this question.