Response to Editorial: CME on the cusp of change


Response to Editorial: CME on the cusp of change

Received: 12 February 2014 Accepted: 12 February 2014 Published online: 4 March 2015

Journal of European CME (JECME) 2015. © 2015 Lewis A. Miller. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Citation: Journal of European CME 2015, 4: 27567 -


You have written a provocative editorial, to which I would like to respond with several factual points and a couple of opinions, from across the pond:

  1. You state that the industry has “shifted its emphasis from promotion to education.” I do not have to hand the data on promotional spending, but I do know that the amount and percentage of commercial support for accredited CME in the United States has declined steadily since 2007 (from over 50 to 26% in 2013), while the total amount of CME income of ACCME-accredited providers has remained relatively steady (2013 at $2.5 million and 2007 at $2.7 million). The major shift in promotional spending by industry over that time period has been from professional to consumer here in the United States.
  2. You suggest that providers in the US must submit their proposed educational activities to ACCME predominantly. This is not true. ACCME periodically accredits and re-accredits providers, based on a review of their procedures and a sampling of past programs. No prospective review is carried out, except by the American Academy of Family Physicians, which as in Europe accredits programs, not providers.
  3. You quote Goldacre as noting that “research has repeatedly shown that doctors who receive money from industry have biased views.” Goldacre, I believe, is discussing what is often referred to as “promotional education” which is NOT accredited CME. Unfortunately, several points in your editorial reflect the same confusion in terms – at least for the United States. A more recent review of literature conducted by Cervero and Gaines for ACCME (April 2014) regarding US-accredited CME states: “The evidence from the literature leads to the following conclusions: 1) Commercially-supported CME can provide clinically accurate medical content; 2) Physicians perceive very low levels of commercial bias (3–5% on average) in post-program course evaluations; and 3) This same level of perceived bias is reported for programs that were commercially supported and those that were free of commercial support.”
  4. The regulations governing the US Sunshine Act, as you note, exempt from reporting any payments made to accredited providers, who then pay honoraria to program speakers. Payments to support physician attendance at Congresses are not permitted, and it is wonderful to see that this practice will diminish if not die out in Europe. Eucomed, the European device industry organization, has already told its member companies to cease such support. EFPIA, the industry voice of pharma, may soon take a similar position, I understand.
  5. EFPIA's own effort to create transparency about payments to doctors is voluntary, and will result only in data published on each company's website. There is no comprehensive site, as in the US, to describe total amounts paid to an individual physician by all companies. In my view, the purpose of any Sunshine Act should be to identify bad apples among physicians and companies. It is a major waste of time and money to collect data on small payments to all practitioners.
  6. The impact of withdrawing delegate support to attend medical specialty society congresses, as you suggest, will be significant, though it is interesting to note that in the United States, as commercial support for accredited CME has diminished, income from other sources has increased. This consists of “participant registration fees, government grants, private donations, and allocations from a CME provider's parent organization or other internal departments.” One might argue, by the way, that since most medical care is paid from government agencies, that those agencies would see benefits in quality and cost control from funding more accredited CME. Societies themselves might strengthen their CME offerings by encouraging industry to devote the savings realized by not sending doctors to congresses to supporting CME activities with direct grants to the societies.
  7. In line with my previous comments, it would be in the best interest of pharma/device companies elsewhere in the world to follow the practices their US companies already have in place: Departments of medical education, reporting to Scientific Affairs, which receive unrestricted funds from sales/marketing and other company budgets, staffed by CME professionals who follow ACCME requirements to fund activities that can result in performance change and improved patient outcomes. It is reasonable to accept that such funding will be allocated only to diagnostic/therapeutic areas in which the company has products, so long as there is no direct relationship between education and product promotion. This practice has eliminated, for the most part, the abuses that existed in the US at the turn of the 21st century, which resulted in a number of fines and other disciplinary actions. The US Department of Health & Human Services has in place clear definitions that separate education from promotion.

Thanks for the provocation!

Lewis A. Miller
WentzMiller Global Services LLC
Consultants in Health Education Worldwide
Personal: 1.212.933.1027

About The Author

Lewis A. Miller
WentzMiller Global Services
United States


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