Strategies for Moving Forward

How should CME be funded? The CME enterprise community has suggested several strategies, including applying FDA application user fees toward CME funding, with the agency distributing monies to accredited providers or the ACCME. This would provide industry support while avoiding the appearance of undue influence. However, while this is a logical approach, it is certain to be met with resistance from industry.

Stanford University has responded to the controversy by accepting commercial support only if it is offered into a "central pool" (i.e. not specific to one activity). Pfizer just announced a $3 million dollar grant to Stanford, using this model to support activities across multiple disease states.

Some Novel Approaches

There are also some more controversial, but appealing, approaches CME professionals are discussing.

Corporate Advertising It may sound like a foolish approach (and it is currently banned by the ACCME), but this is not as strange as one might think. Indeed, most journalistic endeavors—be they scholarly journals, newspapers, or public radio—have been using this model quite successfully for many decades. Corporate advertising could be sold with each CME activity as long as the advertising is kept separate from content development.

At first glance, this looks a bit radical, and it is certain to be met with skepticism. In this approach, you don't ask the funder if your activity is in line with their educational objectives, or if they approve of the budget. One group creates the content and a separate group sells the placements (ad space), sharing just enough information with the media buyers—i.e. the learning objectives and outcome plan—so that they know what topic the activities are going to cover. The ads would be presented in the fashion of PBS: "This activity is made possible by a grant from XYZ Pharma." It's a little impure, perhaps, but more transparent than the current model, where funders review numerous details about a CME activity via the online grant application.

Though currently evolving to meet the demands of the digital age, the advertising model is well-tested, having been applied successfully in print and broadcast media, as well as on the Internet: It is already the primary online funding model, and has worked fairly well—so long as the media keep a firewall between editorial and commerce. In this case, the ACCME can play a role as the kind of defender that newspapers and magazines have never had.

Tax All Grants There are currently vast swaths of underserved CME content areas; industry tends not to support subjects like medication and medical errors, practice management, and non-pharmacologic treatment approaches, which do not align with their educational objectives. A tax could be created to appropriate 10 percent of all grants to accredited providers for funding CME areas that represent unmet educational needs/practice gaps. There is, in fact, a precedent for this in the Prescription Drug User Fee Act (PDUFA), whereby industry pays fees to the FDA, and in return the agency is more accountable and processes drug applications more quickly. The difference would be that of primacy. Whereas PDUFA is central to funding drug applications, a CME grant tax would be an important but auxiliary funding mechanism.

Regardless of which new method the industry chooses, what matters most is that we focus our energy on improving patient care, not navigating a 20-page online grant application or making the system more complex.

Dean Beals is president and CEO of DKBMed. He can be reached at dbeals@dkbmed.com