CONTINUING MEDICAL EDUCATION
CME providers’ total income, opposed to over 50% in 2007.6 Institutions
provided 82% of CME without commercial support. 7 The drop in
commercial support is not necessarily attributable only to industry restraint.
Many factors have influenced the decline, including a weak national
economy, a slowing pharmaceutical pipeline, more rigorous Accreditation
Council for Continuing Medical Education (ACCME) guidelines, and a
general growing criticism of industry-funded CME. 8 ACCME is the body
responsible for accrediting institutions offering CME, developing criteria
for evaluation of CME, and reviewing developments in CME’s support of
quality healthcare. 9 Despite the existence of ACCME Standards for
Commercial Support, which set forth restrictions on how industry can
provide funding to CME providers, they do not go far enough in
minimizing industry influence on CME programs. 10
While the recent decrease in industry support for CME results in
decreased conflicts of interest, it has not eliminated industry influence over
CME delivery. While the federal Department of Health and Human
Services (HHS) has traditionally left the regulation of CME activity to the
ACCME, ACCME has been lax in enforcing its own accreditation
standards. 11 As a result, the Centers for Medicare and Medicaid Services
providers dropped to 687 from a peak of 736 in 2007). Interestingly, commercial support for
CME provided by medical schools has not decreased as sharply, though several medical
schools have begun to adopt policies that shy away from industry funding. See Natasha
Singer & Duff Wilson, Debate Over Industry Role in Educating Doctors, N. Y. TIMES, June
23, 2010, at B1. The University of Michigan, for example, decided in 2010 that it would no
longer accept money from drug and device manufacturers to fund CME activities. Id.
6. See ACCME ANNUAL REPORT-2012, supra note 5, at 10.
7. Id. at 35.
8. Kevin B. O’Reilly, As CME Funding Shifts from Industry, Others Foot the Bill,
AMERICAN MEDICAL NEWS (Sept. 12, 2011), http://www.amednews.com/article/20110912/
9. Accreditation Council for Continuing Med. Educ., About Us, http://www.accme.org/
about-us (last visited Nov. 16, 2013).
10. See ACCREDITATIONCOUNCIL FORCONTINUINGMED.EDUC.,THEACCREDITATION
REQUIREMENTS OF THE ACCREDITATION COUNCIL FOR CONTINUING MEDICAL EDUCATION
(ACCME), 1 (2012) [hereinafter ACCME STANDARDS FOR COMMERCIAL SUPPORT],
available at http://www.accme.org/sites/default/files/626_Accreditation_Requirements_
Document_20120924.pdf; see, e.g., INST. OF MED., supra note 1; Marc A. Rodwin, Drug
Advertising, Continuing Medical Education, and Physician Prescribing: A Historical Review
and Reform Proposal, 38 J. L. MED. & ETHICS 807, 811 (2010).
11. See, e.g., Senate Special Committee on Aging Committee Hearing, INFOTECH NEWS
(July 30, 2009) [hereinafter Nissen Testimony], http://it.tmcnet.com/news/2009/07/30/4301
036.htm (recounting Steven Nissen, MD, Chairman, Department of Cardiovascular
Medicine, Cleveland Clinic’s testimony to the Senate’s Special Committee on Aging,
including that the ACCME’s enforcement is “largely ineffective,” as the organization seems
“uninterested or incapable of enforcing” its own policies); Nissen Puts Stake Through
ACCME’s Heart at Senate Hearing on Industry-Funded CME, PHARMA MARKETING