Updated ACCME Standards for Commercial Support

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Updated ACCME Standards for Commercial Support

• Insights from NAAMECC Audioconference with Murray
  Kopelow and Other Recent Statements
• Eric D. Peterson, EdM, President, NAAMECC
• VP, General Manager, Bimark Center for Medical
  Education
• epeterson_at_bimarkinc.com

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Areas of Concern to Commercial Providers

• Designation as a commercial interest
• Official status of the supporting documents?
• Conflicts of interest
• The discretion of providers in resolving
  conflicts
• The role of commercial supporters

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Q Is there a situation in which a medical
education and communication company would be
considered a commercial interest by the
ACCME? A No. Communications companies are
providers, not commercial interests. Medical
education is not considered a healthcare product
or service. Murray Kopelow, NAAMECC
Audioconference, 10-21-04
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Status of Supporting Documents

• Not part of the Standards
• Not official ACCME policy
• Not reviewed or approved by Member Organizations
• Written by ACCME Staff
• ACCME reluctant to call them guidance
• They are merely resources designed to help
  providers as they develop their own systems for
  identifying and resolving conflicts of interest
  
• Murray Kopelow, NAAMECC Audioconference, 10-21-04

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Personal Conflicts of Interest

• Direct Financial Relationship
• Relationship not primarily held by and mediated
  through an employer, provider, or other
  institution
• Involves the expectation of payment directly to
  the person involved
• Current

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Relationships that Do Not Create Personal
Conflicts of Interest

• Participation in research that is contracted to
  the potential faculty members employer
• Directly contracted research is different
• Honoraria received for CME speaking for which
  commercial support has been received

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Problematic Relationships

• Promotional speaking (speakers bureau)
• Consulting

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Current or Past?

• Current relationships are the primary concern
• Past relationships may be relevant for disclosure
• Providers have discretion in deciding when a past
  relationship may create a conflict
• Many consulting relationships are self-contained

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Resolving Conflicts of Interest

• Providers have considerable discretion in
  determining the mechanisms they will use to
  identify and resolve conflicts of interest
• Providers are encouraged to appeal to
  institutional policies and societal norms for
  managing conflicts of interest in determining
  their own mechanisms

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Does the ACCME Prescribe Censorship?

• ACCME strongly denies this charge
• Examples given in supporting documents represent
  approaches that the ACCME would consider to be
  compliant
• Other approaches are possible and acceptable

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Other Approaches to Resolving Conflicts

• Peer review
• May include content review and validation
  mechanisms
• Best if it has many layers and includes a
  community of teachers and learners
• Activity evaluation by learners or experts
• Citing the best available evidence for patient
  care recommendations

http//www.accme.org/incoming/187_20041020_SCS_Add
itional_Questions_Answers.pdf
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Role of Commercial SupportersNothing has Changed

• Accredited providers may request information from
  commercial supporters, including the following
• Topics
• Speakers
• Providers must act independently in making use of
  this information

http//www.accme.org/incoming/187_20041020_SCS_Add
itional_Questions_Answers.pdf
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Role of Commercial Supporters (contd)

• Arranging for electronic access
• ACCME is concerned about interactions where the
  company representative must be present for access
  to the activity
• Rep distribution of enduring materials is
  considered inappropriate
• Invitations, BRCs, brochures are all OK

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Areas that Remain Confusing

• Spouse or partner
• Selling an activity to a commercial interest
• Academic consulting

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Educating PhysiciansThe Provider's Challenge

• ACCME has no plans to educate physicians beyond
  supporting other stakeholders
• Physicians are the most impacted yet least
  consulted party in the Standards revision
• Providers will end up as the heavies
• Issue
• Many physicians have given little thought to
  managing their industry relationships
• Physicians must now think about all relationships
  in terms of a potential conflict trap

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Implications for IndustryDeploying KOLs

• In what role is a key opinion leader most
  valuable?
• Promotional speaking?
• Consulting?
• CME?

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Summary

• Providers have considerable discretion in
  determining their mechanisms for identifying and
  resolving conflicts of interest
• Personal financial relationships are the objects
  of concern to ACCME
• ACCME draws a distinction between current and
  past relationships
• The rules regarding industry involvement in
  suggesting speakers and topics are unchanged
• We must figure out how to break this to our
  faculty
• ACCMEs thinking continues to evolve as providers
  ask questions

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Questions and Responses