June 9, 2010

John W. McMahon MD, Acting Chair
Council on Ethical and Judicial Affairs
American Medical Association

Dear Dr. McMahon,

The Council of Medical Specialty Societies (CMSS) supports revised CEJA Report 1 A 10.

CMSS recognizes that:

• Line 14 on page 9 clarifies that commercial support can be valuable, but it is not without risks, which are then managed through specific methods, including those in Recommendation 1.
• Lines 21‐24 on page 9 state CEJA’s perception that it has more confidence in CME if it is independent of support.
• Line 46 on page 9 clarifies that CME providers can judge when commercial support will enhance their ability to get important CME to physicians.
• Recommendations 2 and 3 outline management and resolution of disclosed conflicts of interest of individual physicians.
• Recommendation 4 indirectly supports the ACCME – SCS, which serve as the profession’s self‐ regulation of commercial support of CME; and the CMSS Code for Interaction with Companies, which guides specialty societies in relationships with industry.

Since the last CEJA Report on this issue, the Council of Medical Specialty Societies has adopted the CMSS Code for Interactions with Companies. There are many areas of consonance, and a few of dissonance between the CMSS Code and this CEJA Report.

Areas of Consonance:

• Self‐regulation is a professional obligation, part of the profession’s social contract.
• Direct financial relationships between individual physicians and industry are associated with increased influence on physician behaviors.
• When physicians have, and disclose direct financial relationships with industry, those relationships create a conflict of interest, which then must be managed and resolved, for which a variety of options exist, not only recusal.
• Commercial support of CME needs to be managed to avoid the perception, as well as any potential reality of influence.
• The profession should adhere to extant voluntary professional standards governing commercial support of CME and relationships with industry.

Areas of Dissonance:

• Unlike direct financial relationships between physicians and industry, the evidence does not support the perception that commercially supported CME is biased.
• Commercially supported CME not only can be, but is developed and disseminated without any influence of the supporting company.
• In creating and disseminating CME, specialty societies protect the integrity of content which prioritizes the primacy of patient benefits.
• Commercial support of CME is valuable for providers to use to develop and disseminate important new knowledge, as well as important mechanisms of practice performance improvement through CME.
• Offering CME for free or for a subsidized price can reduce barriers to physicians to obtain important CME which physicians might not otherwise choose to obtain.

It is not obvious that CEJA has taken into consideration how the profession’s system of self‐regulation of commercial support of CME is working. For example, since the first CEJA report on this topic at A 08, the profession’s self‐regulator (ACCME, of which the AMA is a Member Organization) has markedly shortened the improvement time‐line for providers found “Not in Compliance” with elements of the SCS, and significantly increased the number of Providers on the path to Non Accreditation for violating the profession’s standards.

Perhaps it would be best for CEJA to limit its focus to revising the Ethical Opinion on Gifts to Physicians from Industry, over which AMA has unique jurisdiction. CEJA should leave the regulation of commercial support of CME providers to the profession’s jurisdictional regulator in that arena (ACCME), and the governance of specialty society relationships with industry to adherence to the new CMSS Code.

Thank you for the opportunity to comment.

Sincerely,

Dr. Kahn Signature

Norman Kahn MD
Executive Vice‐president and CEO