CONTINUING MEDICAL EDUCATION
and private regulatory regimes are mostly ineffective at curbing industry
bias. The Sunshine Act, which was supposed to present the first step in
resolving some of these inefficiencies, similarly will do little to reduce
industry influence on CME.
III. RECOMMENDATIONS TO REDUCE COMMERCIAL BIAS
AND ENSURE INDEPENDENCE FOR CME PROVIDERS
Any form of regulating CME must balance the interests of preserving the
integrity of CME with the need for industry sponsorship to allow quality
CME programming to exist in the first place. The primary reason many
drug and device companies readily pay hundreds of millions of dollars
annually to CME is to sell their products.155 The 2007 Senate Finance
Committee report found that it seems “unlikely that this sophisticated
industry would spend such large sums on an enterprise but for the
expectation that the expenditures will be recouped by increased sales.”156
Pharmaceutical companies would likely not spend hundreds of millions of
dollars per year on CME sponsorship it did not yield significant profits by
influencing physicians’ prescribing behaviors.157 Indeed, the directors and
corporate officers of pharmaceutical companies have a fiduciary obligation
to their shareholders to increase profits.
Without drug and device companies’ financial support for CME, the
availability of accredited CME programming would be diminished. This
argument has merit, as restricting or prohibiting industry funding of
accredited CME would fundamentally alter the way CME is created and
funded. However, it is possible to restrict industry funding or prohibit it
altogether without reducing the availability of quality CME. There are
several changes Congress, CMS, and other entities can make to improve the
reliability and independence of CME in the United States without making
CME admission costs prohibitively expensive.
A. Amend the Sunshine Act Regulation to Require
Disclosure of Indirect Payments to Accredited CME Providers
Passing the Sunshine Act was a positive step in terms of increasing
transparency and accountability in the relationships between industry and
medical practitioners.158 As it had done in its proposed rules, CMS should
155. See, e.g., Nissen Testimony, supra note 11.
156. USE OF EDUCATIONAL GRANTS BY PHARMACEUTICAL MANUFACTURERS, supra note
116, at 16.
157. See Husten, supra note 13.
158. Physician Payments Sunshine Act, 42 U.S. C. A. § 1320a-7h(a)( 1)( A) (West,
