I love this story about a man who had the luck (if you can call it lucky to have to suffer a cardiac event at all) to have a heart attack during a lecture on heart disease at the Central Maine Medical Center. Talk about having a doctor (and some fast-thinking nurses) in the house. After the man was stabilized and sent to the hospital, the faculty member carried on with his talk.

Medical Meetings‘ newest columnist, Rick Kennison, president and general manager of Peer-Point Medical Education Institute, LLC, has made another media debut: A video interview on the ACCME’s Web site called CME Designed to Impact Patient Outcomes. Want to know how one company designs its activities to meet this high level of outcome? This 18-minute video has a lot of good information.

I haven’t watched it yet, but I’m guessing the same level of quality holds for another video recently uploaded at ACCME.org: Using Effective Educational Formats, in which Gordon West, PhD, director of continuing education at the Annenberg Center for Health Sciences at Eisenhower, discusses which educational formats that his organization uses, and how they decide which to use for what activities.

While you’re there, check out all the videos in the ACCME’s growing library. There’s a lot of really good stuff on that virtual shelf.

Reading this editorial by Jerry Avorn in today’s Boston Globe about academic detailing got me wondering why this hasn’t really taken off. Avorn, the so-called “father of academic detailing,” has been critical of the commercially supported CME model and has long proposed academic detailing as a superior educational tool. While I’m not agreeing with that, I do agree that it could and probably should have a place in the CME continuum.

I’m guessing it comes down to money, since it has to be expensive to train and disseminate experts to educate docs at their workplaces on best practices for specific disease states. Avorn seems to think the agricultural Cooperative Extension Service could be a good model to base it on, and in fact cites some similar medical public service programs that he says are successful.

Now that the funding for a pilot program that was included in the original Massachusetts healthcare reform legislation looks to be fading away, who’s going to pay for it in my (and Dr. Avorn’s) home state? He suggests insurers, which seems like an odd choice for someone concerned about undue influence on education—I’d say insurers have a pretty big stake in what’s prescribed, wouldn’t you? And that industry doesn’t have all the safeguards and firewalls in place that we already have for pharma and device commercial support of HCP education, so if anything that would raise the risk of bias sneaking in.

So we still have to ask, if academic detailing is such a good idea, who should pay for it? Or is there something else that impedes this form of education from becoming more mainstream? Is the model itself flawed in some way that I’m not seeing? Maybe today’s plethora of high-quality online educational activities (commercially supported or not) and reference resources are already bringing the information to the docs’ offices so “un-salespeople” aren’t really going to add much to the mix anymore?

I can hear the moans now: The American Medical Association’s House of Delegates has finally approved the latest of its Council on Ethical and Judicial Affairs many versions of proposed recommendations around commercial support and CME. Sigh. I’m with our MM columnist Stephen Lewis on this one: CEJA just officially turned itself into an oxymoron. Never mind what the Alliance for CME thinks, or what I would guess would be the opinion of vast majority of CME providers who actually do this stuff day in and day out.

No, this must mean that at least some of the greater minds at the AMA HOD think it’s a good idea to ignore current safeguards and react to the potential for the perception of some possible problem, rather than base actions on evidence and data.

Remember the study about the potential for bias in commercially supported CME that came out in the May issue of the Archives of Internal Medicine? I (and others) tend to get caught up in the whole actual versus perceived bias argument, but this post on Confessions of a Medical Educator cuts to the chase.

As Derek says, “CME providers don’t talk to commercial supporters about content. We don’t talk to them about speakers. We write our own needs assessments. We write our own learning objectives. We develop the content ourselves and pick our own speakers. There could be one commercial supporter or twenty commercial supporters; the content is still going to be the same.

“Why? The ACCME.”

Go ahead and read the whole post for his argument, which I think is a great one. I can’t help but wonder just how different that survey results would have been if those who participate in CME activities really knew where and how the content was developed, and by whom. Once again, CME providers, we need to do a better job of letting people know just what it is you do, and how hard you work to ensure that healthcare providers are getting what they need to improve patient care. Then those “perceived versus actual” arguments fall away. Or should, anyway.

“We have decided that we will no longer pay for doctors to attend international scientific and medical congresses but will instead focus our educational efforts on local educational opportunities for healthcare professionals,” said AstraZeneca chief executive David Brennan at a conference in Istanbul in May, according to a Reuters report. This makes the drug firm the first to drop the practice of financially assisting foreign physicians who want to attend medical congresses outside of their home countries.

The reason Brennan gave for the policy change is that the company wanted to ensure that it didn’t do anything that could be perceived to be a bribe to get an HCP to prescribe its products, according to the article. The pharma industry has been under a lot of scrutiny in recent years, something that has further intensified when it comes to cross-border meetings due to investigations triggered by the U.S. Foreign Corrupt Practices Act and the U.K.’s new Bribery Act, which is expected to go into effect in July.

Given this environment, Richard Bergstrom, director general of the European Federation of Pharmaceutical Industries and Associations, told Reuters that he anticipates other companies may well follow suit.

What do you think about AstraZenica’s decision to stop funding foreign physician travel to meetings? Will it significantly affect attendance at large U.S.-based meetings? Do you expect other companies will in fact follow suit?

Please leave a comment below, or e-mail some thoughts. I’m thinking that, if a lot of companies do follow AstraZenica’s lead, it could put a world of hurt on some of our large national medical association conferences. Not to mention that it would cut off a fairly major source of education for physicians, especially those who come from countries where CME is not as prevalent or well-policed for bias as it is in the U.S.

How did I not know that Derek Warnick had a blog? Called CME Confessions, it has me riveted. So far, I haven’t gotten past this post on cruise CME (you know, CME that takes place somewhere fun, like a cruise ship or a ski resort). He pretty persuasively argues that, if you look at it objectively, as long as it’s not commercially supported, this type of CME is actually something we should strive for. While a commenter says that, because there’s entertainment along with the education, these types of activities are out of compliance with the ACCME’s Standards for Commercial Support, specifically SCS 3.11 (“Social events or meals at CME activities cannot compete with or take precedence over the educational events.”).

I find it hard to believe that the SCS apply to non-commercially-supported activitiesthat just doesn’t make any sense to me. But I do see that the old perception thing will get in the way. I remember writing an article way back when about the more logistical benefits of cruise CME, which sounded pretty persuasive to me at the time. Funny that the issue of commercial support isn’t even brought up in the article. Then again, it was written a while ago.