Pfizer’s Policy Changes Affect CME

A recent decision by Pfizer to eliminate all direct funding for continuing medical education/continuing education (CME/CE) programs conducted by commercial providers including medical education and communication companies (MECCs) raises questions about whether it is an isolated action or a signal that MECCs will no longer conduct business as usual.

Accredited publishing/education companies, a category that includes MECCs, received $620,657,405 in commercial support in 2006. This com­pares with $259,058,755 for medical schools and $179,932,423 for nonprofit physician membership organizations, according to Accreditation Council for Continuing Medical Education (ACCME) data.

Pfizer’s revised grant criteria is posted at its Web site.¹ Direct funding of MECCs stopped on July 2, with the exception of preexisting commitments, said Sally Beatty, director of Pfizer Inc’s global media relations.

Pfizer’s expenditures from CME have declined over the past few years, but the drop to $60 million for 2008, according to Pfizer, is not a result of the MECC direct-funding exclusion.

“Our resources are limited . . . we have made a strategic policy decision that will place our funding where it is likely to make the greatest impact on patient care,” Pfizer said. The company will focus more on performance/ quality-improvement–based education and practice-based learning and less on traditional dinner programs, satellite symposia, and lectures.

Role for MECCs?

Despite its cutoff of funds for MECCs, Pfizer still predicts a role for these providers in medical education.

The company will continue to fund CME initiatives that involve MECCs as long as they are not the primary sponsors, said Michael Saxton, MEd, FACME, senior director and team leader of Pfizer’s medical education group in the United States.² MECCs should collaborate with hospitals, associations, and academic medical centers, he said.

In explaining Pfizer’s policy change in a letter to CME/CE provid­ers, Joseph Feczko, MD, the company’s chief medical officer, said, “We believe this change will significantly address the ongoing criticisms of conflicts of interest in industry-supported CME/CE which persist despite increasingly high firewalls to protect against conflicts.”

Some criticisms have emanated from the US Senate Finance Committee and the Josiah Macy, Jr. Foundation, among others. In its 2007 report on the use of educational grants by pharmaceutical manufacturers,³ the Senate Finance Committee’s staff argued that pharmaceutical companies, according to ACCME records “had too much influence over the content of supposedly independent educational programs” and that there were problems with for-profit medical education and communications companies. The Josiah Macy, Jr. Foundation report⁴ went so far as to exclude MECCs from its list of organizations that should be eligible for ACCME accreditation.

Beatty denied that the Macy or Senate reports influenced Pfizer’s policy change.

“This change reflects a new strategy to address real practice concerns,” she said, adding that Pfizer believes its support should be aligned with the highest level of standards endorsed by the medical community, such as those found in the new ACCME criteria.

Opposition to change

The North American Association of Medical Education and Communication Companies (NAAMECC), an advocacy and education organization for MECCs, worries that Pfizer’s action might be interpreted by academic medical centers and others that they too should not support medical education companies.

If that occurs, then “many MedEd companies will be effectively out of business,” to the overall detriment of the entire medical education community, the association warned.

NAAMECC also said that “100% of the accredited MedEd companies, as a condition of ACCME accreditation, have demonstrated separation of promotion from education,” a key criterion for establishing their independence from commercial support.”

“The stark reality is that the continually evolving and rapidly advancing pace of medicine today requires the greatest number of options in physician education,” Michael Lemon, MBA, NAAMECC’s president, told Psychiatric Times.

All CME providers must protect the public interest by preventing undue influence from industry on the content of CME activities, he said, noting that the association has just completed a Code of Ethics and launched a fund-raising effort to finance a collaborative national audit of bias in commercially supported CME conducted by various provider types.

Pfizer’s policy change also has rankled the Coalition for Health Care Communication, an advocacy group composed of member organizations.

Pfizer’s decision is “an honest but misguided attempt to blunt public criticism of commercial support,” the coalition said.

Commercial providers, according to the coalition, achieved the highest ratings of compliance (94.8%) of any group surveyed for all elements relating to ACCME’s Standards for Commercial Support. What’s more, the coalition said, commercial CME pro­viders are responsible for many “robust innovations to CME,” such as developing interactive and multimedia techniques that actively involve learners in programs and outcomes and developing Web-based learning platforms and programs designed to address the immediate needs and time constraints facing clinicians.

Stricter criteria for all

Beyond eliminating direct funding of MECCs, Pfizer is requiring that other accredited CME providers (eg, academic medical centers, medical schools and professional medical associations) must meet “revised, stricter criteria.” All major grant applicants must “meet criteria equiv­alent to ACCME’s highest level of accreditation.”

This does not mean, however, that CME providers had to have the accreditation with commendation status as determined by ACCME, Saxton said, but rather that “Pfizer supports initiatives that mirror the highest standards accepted by the medical profession. . . . We support initiatives that are likely to improve patient health and reflect the literature on effective change strategies.”

Other Pfizer changes include the initiation of a competitive grant review period for grant applicants and establishment of financial caps on grant supports to achieve balanced funding in CME. As of September 1, Pfizer would no longer provide grants to organizations that receive 90% or more of their income from commercial support.

Many of the changes as well as an updated Frequently Asked Questions section are posted on Pfizer’s Website. Of Pfizer’s 2008 CME grants budget, Beatty told Psychiatric Times that grants related to psychiatry and psychology would account for about 20%.

As part of its policy changes, Pfizer recently endorsed updates to the newly revised PhRMA Code on Interactions with Healthcare Professionals, which takes effect in January 2009.⁵

References:

References

1. Statement on Pfizer’s recent policy change on CME support. www.pfizermededgrants.com/pfizercme/ help/statement.html. Accessed August 4, 2008.

2. Pfizer cuts off funding for medical education companies. MeetingsNet. July 2, 2008.

http://meetingsnet. com/medicalmeetings/news/pfizer_cuts_funding_med_education_0702/index.html

. Accessed August 4, 2008.

3. Staff of the Committee on Finance, United States Senate. Committee Staff Report to the Chairman and Ranking Member, Use of Educational Grants by Pharmaceutical Manufacturers. Washington, DC: US Government Printing Office; 2007.

4. Hager M, Russell S, Fletcher SW, eds. Continuing Education in the Health Professions: Improving Health­­care Through Lifelong Learning, Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation; 2007 Nov 28 - Dec 1. New York: Josiah Macy, Jr. Foundation; 2008.

5. Pharmaceutical Research and Manufacturers of America. Code on Interactions With Healthcare Professionals.

http://www.phrma.org/files/PhRMA%20 Marketing%20Code%202008.pdf

. Accessed August 4, 2008.