CME Spotlight: Moving CME forward in Europe
pharmafile | October 15, 2009 | Feature | Medical Communications |Â Â CME, CME Spotlight, Eugene Pozniak, ethicsÂ
As a young advertising account exec in the early nineties I was once told not to concern myself with any new-fangled production techniques as computers would never catch on. I have heard similar sentiment over the past ten years while working in Continuing Medical Education (CME): that this fringe interest may fascinate eccentrics in Europe, but that it would never come to much.
But CME in Europe has steadily grown, and is now moving fast enough to be a worthy subject for this, my new monthly column. I’ll focus on developments in European CME, and touch on the difficult-to-ignore CME business in the USA where it overlaps with Europe.
On that note, GSK’s US operations have just announced that it is stopping funding of CME through third party Medical Education and Communications Companies or MECCs.
This follows a very similar move by Pfizer last year. But what does it mean? And will this affect us in Europe?
MECCs have attracted a disproportionate percentage of CME funding from pharma, but have gained a bad reputation in the US.
Most have worked to the strict rules set by the accrediting body the ACCME, which stipulates that CME must promote better healthcare, and must not promote the commercial interests of a company. In essence, a few organisations have fallen short of these responsibilities, and these bad apples allegedly originate from within the MECC community.
Many MECCs have developed very high quality CME, but all have now found themselves tarred with the same brush.
Pharma companies are now distancing themselves from the problem, even though they as a community have helped create it. The industry is now looking for alternatives, and wants education providers to adhere closely to the ACCME rules. The most forward-looking pharma companies are those who are taking steps to actually work out what they want to achieve by supporting CME. They are making more stringent quality demands of their education providers and relationships, rather then just reiterating the ACCME rules, or playing to the gallery and abandoning all MECCs.
In Europe, our system is very different, but while the US changes won’t have a direct impact, we must take note of how this situation has arisen.
Globalisation of the pharma industry may have shifted some centres of power away from Basel, Frankfurt or London, but many things have resisted streamlining and clear contrasts still exist between the US and Europe: clinical researchers still see differences in good clinical practice, product promotion practices vary greatly, and we see clear differences with CME and how it is put into practice.
Convergence is coming to Europe
Firstly, CME in Europe is seen more as an ‘ethical obligation’ – it isn’t mandatory as it is in the US, which has helped stop it turning into a commercialised environment.
The system in Europe also looks dissipated and fragmented, but it is converging. Just last month the largest meeting to date of CME accreditation bodies took place during the ECCO/ESMO conference. Representatives from national CME authorities from 17 EU countries, pan-European CME accreditation bodies as well as UEMS shared their ideas about CME and ways to work more closely together. Things are moving forward for a more standardised European CME environment with closer co-operation on a broad range of topics from cross-border recognition of CME credits, accreditation of e-learning CME, quality standards, role of financial supporters, and managing potential bias. This organic growth is also helping European CME to develop, with a firm eye kept on actual value to practicing doctors and patient outcomes.
Both sides of the Atlantic are looking at this specifically now – the difference is that in Europe it is being crafted within an evolving system, whereas in the US it needs to be reverse-engineered: a far more difficult task.
At times it is a little too relaxed in Europe, if, as recent estimates suggest, about half of all CME is funded by pharma, then it should warrant mention in the EFPIA Code of Practice. It may demonstrate that European pharma is not driving CME as it has done in the US, but the time is right for new and more clear-cut rules.
Is the ‘Swedish Model’ the future?
The UK industry association the ABPI is taking a lead on this issue with its ‘VITA’ agenda. Its aim is to improve the relationship between pharma and doctors, including the way pharma funds CME (or CPD as it is known in the UK). CME falls under the “T” in VITA and stands for Trust. The Trust Imperative is being overseen by Andrew Powrie-Smith, and a consultation process is already underway with member organisations and the Royal Colleges to examine possible changes to funding arrangements for CME.
One possibility is the ‘Swedish Model’ where pharma funding would be capped at 50%, the rest being provided by the employer (eg NHS) or the learners themselves. As the only profession historically not to pay for its own CME, the debate has already unveiled a variety of opinions among doctors.
Powrie-Smith is also keen to drive responsibility for CME funding away from the pharma marketing functions and place it within medical affairs (which is already being put in place globally by some leading companies).
This excites me the most: if there is a single action a pharma company can do in European CME to elicit ‘Trust,’ this is it. It has also gained the avid attention of CME accreditation bodies.
European CME is moving forward thanks to a culture of mutual understanding and dialogue.
In November there will be a second meeting in London of the largest CME gathering outside the US. The European CME Forum (of which I am one of the organisers) brings together the three stakeholders in European CME: medical professionals and accreditation bodies, pharma and the education providers (education agencies) and addresses the issues that currently affect European CME.
Additionally a new initiative will be launched where education providers will be able to define their own place within the evolving European CME environment, by demonstrating that they can be credible and responsible education partners in light of developing ‘hands off’ pharma requirements, and how they can better serve patient care: the primary objective of CME.
Eugene Pozniak is managing director of Siyemi and learning and programme director of European CME Forum. Email: epozniak@siyemi.org
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