Conflict Resolution - Pharmaceutical Executive

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Conflict Resolution
In the dangerous intersection of content, conflict, and compliance, med ed needs the fourth "c," context, to stay out of harm's way.


Pharmaceutical Executive



Tom Larrañaga, group publisher of Pharmaceutical Executive magazine, with Steven Mankofsky, strategic account director, Advanstar Medical Economics, and Jerry Silverman, RPh, president of Bimark Medical Communications;
Most important, of course, is that in order for CME to serve the public's interest, what is taught needs to be true. There is promotional education that is valid and has face validity. But what distinguishes continuing medical education from promotional education is that CME is by and for the profession. The content has been created independently from any commercial interest.

I am not saying that education dependent on commercial interest is wrong, or invalid, or not true. It is just education created by commercial interests and not by the CME system."


Andy Bender, principal of Polaris Management Partners
"The Big Picture The content or format of a CME activity or its materials must promote improvements or quality in healthcare. That is the most important goal of CME, and we need to focus on that because that is what ACCME's member organizations, the public, and the learners expect."


Eric D. Peterson, MEd, president of the National Alliance of Medical Education and Communications Companies (NAMECC), and vice-president and general manager of Bimark Center for Medical Education.
"Mechanism One of the big new issues with these updated standards is resolution of personal conflicts of interest. Here, the most important things to the ACCME are the word 'mechanism' and that providers are engaged in the process of managing, or resolving, conflicts of interest. This has two major components—the identification and the resolution. Resolving conflict of interest means taking steps to ensure that the content of the activity is aligned with the interest of the public. When a relevant financial relationship exists and the content is relevant to that commercial interest, providers must insert safeguards against bias. Providers can, for example, address conflict of interest through managing a person's role or assignment in CME, or through external validation of content. We are moving away from just disclosure of relationships and raising the bar. A disclaimer saying, 'I know this is a biased presentation because I firmly believe it,' is not a standard that we use for managing conflicts of interest. External validation can be accomplished by reference to the scientific literature. There are evidence-based reviews and meta-analyses and syntheses for almost everything that we do as physicians. We need to recognize that quoting the literature, citing four articles that support what is being said, is very different from referencing a meta-analysis or meta-synthesis as the best available evidence. This expectation has been articulated in ACCME's 2002 Content Validation statements.

Another example of external validation is the circumstance where the educational space contains the world's experts. When someone brings new information from his or her own research or offers personal thoughts of what should be done, it is effectively being subjected to a peer-review process because the room contains peers who can judge what they are being asked to learn. They can say, 'this is biased,' 'this is only because of your commercial interest,' or 'the data don't support that conclusion.' That process, that mechanism, resolves conflicts of interest. There are safeguards in place. This is the way professionals and clinical scientists interact, at the expert level."

"Enduring Materials The 1992 SCS said a commercial interest could distribute enduring materials, and the provider was responsible for their use as a CME activity. In element 4.5 of the 2004 Updated SCS, ACCME says providers must not use commercial supporters as a distribution vehicle for a CME activity. The goal of this [SCS] element is to separate detailing from the physician's participation in CME. 'Let's sit down and do this activity together while we are detailing the product,' fails to separate education from promotion. But it's not up to ACCME to say what commercial supporters can buy or do. ACCME does not regulate commercial supporters; they are accountable to other organizations or institutions."


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