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Executive Summary

Continuing medical education programs will face significant cutbacks as pharmaceutical companies and health care organizations turn their focus to cost containment in anticipation of health care reform, according to Glaxo, Inc. Chairman and CEO Charles Sanders. Sanders made his prediction at the American Medical Association's Fourth National Conference on CME Provider/Industry Collaboration Oct. 5 in Washington, D.C. Due to health care reform and downward marketplace trends, Sanders explained, pharmaceutical companies "are really going to have to control expenses in a very careful way." One result of that cost containment is that "inevitably, we are going to downsize CME." As evidence of his prediction, Sanders said "19 pharmaceutical companies polled a month ago as to what would occur as health care reform takes place and perhaps more importantly in the marketplace we are currently dealing with, said that they would downsize their medical continuing education effort." CME programs funded by pharmaceutical companies in the future will be more focused on specific products rather than general discussions of diseases, Sanders forecast. With downsizing, "there are going to be fewer independent and broad based programs focusing on disease; they are going to be more targeted for a particular product," Sanders commented. "I don't think that is good, because I think it is important to talk about disease and then the way a particular chemical entity treats that disease...but that may be, in fact, what we have to do," he added. Another senior Glaxo exec, Robert Ingram, told an April meeting of the Pharmaceutical Advertising Council to expect spending reevaluation on promotions and educational projects. The pharmaceutical industry will seek to convey CME information in the least expensive way possible, Sanders predicted. "There will be a greater reliance on alternative and cost-effective technologies, perhaps interactive programs rather than large symposia," he said. The costs of supporting CME programs will be passed eventually to the physician, Sanders suggested. "Institutions will have to pay a greater share of the CME if the industry pulls back," Sanders said, and since "cost containment pressures are also going to squeeze them, that is then going to place greater reliance upon the professional to pay a greater share of CME expense." As a result, "they will probably attend fewer programs." A number of "regulatory disincentives" also are making CME less attractive to drug companies, Sanders observed. Among those disincentives are the rules preventing sales reps from distributing materials, prohibiting the CME sponsor from seeing the program before agreeing to the grant, limiting ancillary communications on related products, and financial disclosure requirements for CME instructors. FDA's final CME policy outlining many of these regulatory proposals is now expected to emerge by the end of November. "It is my earnest hope and my expectation we will have it out this fall in the final form," FDA Policy Development and Coordination Staff Director David Adams said at the meeting. The agency received 150 comments on the "Draft Policy Statement on Industry-Supported Scientific and Educational Activities" published in November 1992 ("The Pink Sheet" Nov. 30, p. 13). The final policy will address a number of issues raised in the comments, he noted. The Accreditation Council for Continuing Medical Education is taking a closer look at pharmaceutical company involvement as CME providers. Executive Administrator Sue Ann Capizzi said the group's planning committee is holding "an extended meeting this November to deal with various issues and provide clarification to sponsors where we see appropriateness of relationships." Responding to a suggestion that accrediting drug companies constitutes an inherent conflict of interest, Capizzi said ACCME "cannot uniformly wipe out all pharmaceutical companies from eligibility until such time as we look at each of these issues; it is going to be on a case-by-case basis." ACCME has launched a pilot random monitoring program to measure compliance to its guidelines by CME providers accredited by the group. ACCME Chairman Robert Tupper, MD, said the organization currently is surveying 100 providers "for compliance with the essentials and the standards." When the system detects a violation, Tupper said there will be an "immediate on-site survey." He noted that all nationally accredited providers are now paying a $500 annual monitoring fee.

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