Paying their own way: pharma and doctors to share CME costs
pharmafile | October 8, 2009 | News story | Medical Communications |Â Â CMEÂ
The UK could be heading for a major overhaul of its Continued Medical Education (CME), as pharma and doctors look set to go 50-50 on funding.
Industry has traditionally paid for 100% of all CME programmes it gets involved in, facing suspicion over its influence on physicians. But the radical idea of sharing costs with individuals could soon be worked into a new Code of Practice, with advocates hoping for a new kind of trust between companies and doctors.
The change coincides with changes to CME policy in the US, though experts say there is a world of difference between the two continents.
The ABPI this summer made a bid to ban many types of promotional gifts to doctors, seen as frivolous and unrelated to clinical practice.
As part of its 'VITA Agenda' to improve industry relations, it also sent out a consultation to its members proposing a move toward sharing funding of continuing medical education (CME) for doctors with other organisations.
Though not released publicly, Pharmafocus has discovered it contained proposals for doctors to go 50-50 with the industry on funding CME, to ensure doctors really want to participate, and do not just accept freebies. In the UK, clinicians are given an annual budget every year from the NHS for training, and it would likely be this that they put towards the costs.
Both proposals were contained in the Royal College of Physicians report published in February 2009, though in May the ABPI said it wanted to take the lead on the ideas rather than wait to have them forced upon them.
The industry association looked to Sweden in forming the proposals as the country has a model of co-funding for CME.
Once ABPI concludes its consultation with member, submissions for which were due by 25 September, it will open it up to wider debate. Any agreed change will then be incorporated into the new ABPI Code, expected next year.
Sarah Jones, education and skills manager at the ABPI, said: "Its aim is to review the way in which medical education has been carried out in the past, to find out if it is still appropriate for today. And if not, what should we be doing differently."
Industry response
GSK UK's medical director Pim Kon said at the moment the company was still consulting on it and didn't have an official position yet, but she was largely positive.
"We will look to work with the ABPI towards a co-funding arrangement – capping what the industry pays and doctors then pay the rest."
She said it was working towards overall industry transparency, which is something GSK feels is important. But though for change in principle, Kon also added that the downside would be the administration.
"For large companies like us it would create a lot more work. Physically co-ordinating it will be horrendously difficult." She also said it could take time adopt the new way of working in practice.
Physicians
The Royal College of Physicians has indicated that doctors and employees should take more responsibility for their continued education, and not rely on industry to provide it.
It received some conflicting views on its own consultation relating to CME, with some speaking of the "excesses of industry," but some arguing the education was useful, raising awareness about new medicines. On balance it said the NHS must "revitalise its role in disseminating evidence-based resources to strengthen postgraduate medical education."
Europe and the US
Expert Eugene Pozniak, who organises CME forums in Europe, has welcomed the ABPI approach as a step forward.
"We can see this happening through the collaboration of decision-makers coming together to make sensible new rules that most people agree with."
However, he says this will never happen in the US, due to the difference in culture.
In the US CME is much more commercialised than in the UK and Europe, with its CME market worth up to $3bn a year – not dissimilar to the GDP of a small country in Europe. Pozniak says this is because the difference in culture.
"The worry that health care professionals maintain their competency and license to practice medicine is different. Salaries are different, and the amount of money involved. In Europe we don't have the washing, bottomless pit of money that the Americans companies have to throw at all these things."
But many now see the US model as broken due the increased commercialisation that compromises its independency and quality, causing major shifts in the way it is done.
Medical Education and Communication Companies (MECCs) in the US – which don't exist in the same way in Europe – are now regarded so poorly that big pharma do not want to be seen to support them.
GSK just announced a change in policy for paying for CME in the US, declaring a more rigorous and transparent approach to its sponsorship. It follows Lilly's action in 2007, when it became the first company to publish its CME funding online and Pfizer the year later, which went further by declaring it would no longer work with US medical education agencies.
Pozniak says Europe is completely different to the US, but it must still work to try and protect itself from the same situation happening.
"In Europe we are developing our CME system, and that really is an evolving process that is organically growing. The CME bodies are constantly revising things and reviewing what's happening, and its much more collaborative. Bodies are much more willing to talk between themselves."
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