AMA CEJA 2010: ACRE Recommends Rejecting CEJA Report

In response to the American Medical Association Council on Judicial and Ethical Affair's (CEJA) fourth attempt to hinder physician and institution relationships with industry, the Association of Clinical Researchers and Educators (ACRE) recommended (HERE) that CEJA Report 1-A-10 and its recommendations be rejected by the AMA House of Delegates.

CEJA’s report, entitled “Financial Relationships with Industry in Continuing Medical Education,” improperly asks individual physicians and institutions of medicine to not accept industry funding to support professional educational activities.  As a result, ACRE has called for the rejection of 1-A-10 for many reasons including:

• CME is already highly regulated to prevent undue influence from industry.

• Reducing resources in CME will result in less education of physicians.

• With the adoption of Health Care Reform and the subsequent addition of 30 million new patients to the healthcare system, additional financial resources will be needed to educate a greater number of physicians and other healthcare providers not less.

• The CEJA report ignores 3 recently published studies, involving very large study populations, which are directly relevant to the Report's subject matter but "contra" to the report's recommendations. By an overwhelming margin, doctors who actually attend commercially sponsored CME do not perceive bias.

• Passage of the Physician Payment Sunshine Provisions in Health Care Reform eliminates the need for more detailed disclosure as recommended in the CEJA report.

By ignoring ACRE’s previous response (HERE) to their third report (HERE) and ignoring recent evidence that industry support does not produce bias in CME, the most recent CEJA report is contrary to evidence-based professional ethics.  In fact, the report is a virtual replica of the previous report that was rejected on three separate occasions by the House of Delegates.  The most recent version contains the same 57 references and includes the same disclaimer that “to date, there is no empirical evidence to support or refute the hypothesis that CME activities are biased.” 

CEJA further acknowledges that presently, it “has not been clearly demonstrated to what extent the amount of a financial interest may influence perception and judgment” Instead, CEJA declares that “clear evidence is lacking” and acknowledges that most policies on “conflict of interest” at least tacitly assume that the greater the financial interest, the more problematic that interest is, but without any evidence.

What evidence does exist about commercial support of CME?

This past year, three studies produced substantial data that demonstrate a lack of commercial bias in industry-sponsored CME (Cleveland Clinic; Medscape, and UCSF). So what did CEJA do with these data?  Nothing.

Ultimately, ACRE’s response reflects the organization's understanding, which is founded on experience and data, that there is value to physicians, medicine, medical education, and patients from the working relationship between physicians and industry. There is no conflict in advancing science, and there is no conflict in providing the education that is required to do so.

By working together with industry colleagues, physicians can explain to the public that the contributions of corporations to medicine are, on balance, more beneficial than harmful and that both medicine and the industries that provide it with its technologies are worthy of public support. Cooperation, instead of antagonism, can help industry develop and market therapies with the highest integrity, by keeping physicians current on the best available evidence and by providing excellent patient care.