COMMENTARY

Responding to the American Siege Against Continuing Medical Education

 


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Continuing medical education (CME) is under siege in the United States. This movement was partly initiated on these pages by the then President of the Association of American Medical Colleges (AAMC) in 2006.[1] President Cohen condemned most CME and called for a new system to "employ self-directed, interactive, and relevant learning experiences...." Many changes in CME were overdue. In 2007, the Josiah Macy Foundation funded a carefully selected elite group to go to Bermuda to analyze continuing education (CE) in the health professions and make recommendations. It too trashed almost all existing CE and made many good, and some questionable, recommendations.[2] After declaring that there should be no industry support for professional education, the Macy authors recommended that "Organizations authorized to provide Continuing Education should be limited to professional schools..., not-for-profit professional societies..., healthcare organizations..., multi-disciplinary practice groups..., professional journals" -- in other words, all the constituencies that were represented in Bermuda by those who wrote the report. Rampant conflicts of interest. And the latest data on the performance of US medical schools on conflicts of interest published last week by the American Medical Student Association gave only 7 schools an A, 14 B, 4 C, 19 D, and 60 F's.[3] And those schools are supposed to be following AAMC rules. Iowa Senator Charles Grassley, who rarely lets a day go by without attacking the pharmaceutical industry, has introduced legislation requiring open full disclosure as a better answer than banning industry-education cooperation.[4] Jerry Kassirer has taken the opposite position on these pages in 2007.[5] Then there were the JAMA editors who wrote in 2008: "...providers of continuing medical education courses should not condone or tolerate for-profit companies...providing funding or sponsorship for medical education programs....[6]" This is from a publication that, for more than 100 years, has been supported primarily by advertising revenue, mostly pharmaceutical. The editors will say "yes, but we follow rules to prevent bias or improper influence." True. So do we, a for-profit company, follow rules that prevent bias and improper influence. There is more. A report of the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association is planned for presentation to a reference committee later this month. This report would prohibit on ethical grounds most doctor-industry relationships.[7] It reads like something from 1-2 decades ago, before the numerous current CE safeguards were instituted. CEJA should withdraw this report before the meeting and bring stakeholders together to strive for a more informed revision for possible presentation at a later date.

What does all this mean for Medscape and eMedicine, the largest single source of CE for health professionals? We are just going to keep doing what we are doing. It is good. We are clean. Our work is transparent. We provide what Jordan Cohen described above, and we provide it free of charge and without need for travel, and we keep records. We welcome analysis and criticism. We function in the best interests of patients, the public, the professions, and our shareholders. Large numbers of physicians, nurses, and pharmacists depend upon us for their CE. We will not let them down.

That's my opinion. I'm Dr. George Lundberg, Editor-in-Chief of The Medscape Journal, Medscape Core, and eMedicine.

 

 

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