The Impact of Industry on Continuing Education 

David Julian Martin, CAE

The Society of Critical Care Medicine (SCCM) offers a wide range of continuing education activities, such as live conferences and workshops, presentations of selected scientific papers, and print and electronic enduring materials. Research grants, ICU surveys, focus groups, and educational enhancement programs have also been developed. The results of these activities have been used to improve healthcare training and performance to achieve high-quality care delivery and positive patient outcomes.

In order that these educational activities are available to the widest possible audience, costs for program development and implementation have often been offset by funding from industry. To ensure the integrity of our many programs, the SCCM Council set in place a number of policies and procedures. In 2003, SCCM’s Council (the organization’s top oversight and policy-making body) commissioned an ad hoc task force to examine the impact industry may have on the Society’s continuing education programs and to develop a full report and analysis for Council’s review.

The working group consisted of representatives from Council, the Educational Affairs Division Steering Committee, staff involved in educational program planning, and staff charged with securing funding to support educational programs, along with an industry representative. The task force reviewed SCCM’s Continuing Education Policies and Procedures Manual, “Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Healthcare Professionals,” “Office of Inspector General Compliance Program Guidance for Pharmaceutical Manufacturers,” and Alliance for Continuing Medical Education’s Almanac.

As an accredited provider of continuing education from the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and American Association of Critical-Care Nurses (AACN), the Society is required to abide by these organizations’ established standards and criteria in order to maintain its accreditation status to award continuing education credit for educational activities. While defining its continuing education program strategy, the Society adopted the SCCM Policy on Commercial Support. According to this policy, which was developed in accordance with the Standard for Commercial Support of Continuing Medical Education of the ACCME and Criteria 17, Noncommercialism of the ACPE, SCCM acknowledged the following:

• - Any continuing education activities supported by educational grants from industry would be balanced, objective and scientifically rigorous

- SCCM would be responsible for the administration, content, quality, and integrity of all continuing education activities

- SCCM would be totally responsible for all decisions on activity development, promotional materials, text content, faculty approval and guidance, activity evaluation, and issuance of certificates

- SCCM would be responsible for the quality, content and use of instructional materials

- SCCM would require faculty to disclose all conflicts of interest to the audience, and to utilize generic names rather than trade names of a product
 
- SCCM would require industry supporting the activity to sign a Letter of Agreement

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• - All financial support received for an activity would be acknowledged by SCCM.
  • Further, the Society ensures that industry sales and/or marketing representatives are to:
  • - Not be involved with the program development process
  • - Avoid distributing promotional materials (product) from the meeting rooms immediately before, during, or immediately after an educational activity
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  • - Avoid placing advertisements for their products within the promotional materials
  • - Refrain from sales activities while in the meeting room where the educational activity is being held
  • - Not provide funding to pay travel, lodging, registration fees, honorarias, or personal expenses for non-faculty attendees

The Society also established its Policy on Delivery of Continuing Education via the Internet in September 2002, which included the following key provisions:

• - No continuing education activities accredited by the SCCM will be placed on a pharmaceutical or device manufacturers’ product Web site
• - There will be no links from the SCCM Web site to industry Web sites before or after the educational content
• - No links to industry will be embedded within the educational content
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• - Advertising within the educational content will be prohibited.

The document submitted to Council detailed all of the above policies, including document samples and current industry guidelines in this area. In addition, the report noted that SCCM relies greatly on support from industry for many activities, and accepts funding by way of exhibiting, advertising, and program sponsorship. The report also noted that the Society asks for funding for substantive educational programs and therefore has been successful at securing large grants that reduce the overall cost of programs and provide for wide distribution at no or a reasonable cost to healthcare professionals.

However, the Council noted that the Society recently was unable to accept certain sizeable sponsorship activities, as its policies have often been viewed as more restrictive than similar organizations, which may permit sponsors to place product-specific logos on any sponsored item. In September 2002, the Council reconfirmed its policy to prohibit the use of a product-specific logo on any sponsored item, including badge holders, registration bags, etc. The policy has been deemed more restrictive, yet Council continues to believe that it reinforces the fact that educational events are Society-sponsored events
supported in part by industry grants, and not in fact product advertising opportunities for industry.

After a lengthy review of the task force’s analysis and recommendations, the Society’s Council made the following determinations:

2. Staff should seek to measure the value to members of industry-sponsored items such as free CDs, monographs, wall charts, and other items that are frequently distributed to SCCM membership after an educational event.
4. The importance of periodic reevaluation of fundraising and sponsorship policies was emphasized and will continue regularly at the staff level. In addition, the matter will be brought back to Council periodically.
5. Council suggested that reductions in industry funding be included in the scenario planning activities developed by the Strategic Planning Committee to determine the impact restricting sponsorship would have on the Society’s educational programs. Council reaffirmed the value of industry partnership and the many benefits that can be achieved by partnering with industry. Current SCCM policies outlining industry partnerships were also reaffirmed and were noted to be effective at safeguarding the Society’s educational mission.
   

Finally, in order that the membership might be made more aware of these activities, keynote speaker George Lundberg, MD, former editor of the Journal of the American Medical Association and currently of WebMD Medscape Network, spoke at SCCM’s 33rd Critical Care Congress in February about how a balanced relationship between medicine and industry can exist. In his plenary session, “Interface Between Clinical Care, Industry, Reimbursement,” Dr. Lundberg emphasized ethics as the moral ground on which both medical practitioners and industry representatives must base their interactions. He outlined three guiding principles to consider when establishing a relationship with industry: ensure that 1) the business relationship is valid and valuable for patients or consumers; 2) the relationship is not exclusive; and 3) once a relationship is established, it is announced to the public. Dr. Lundberg concluded his talk with a word of advice to the 2500 attendees: “You need to look at who benefits, who profits, who loses, who pays. And then you can make value judgments.”

The Society, in all of its educational programs, already follows these recommendations, and more importantly, has developed its own detailed guidelines that define its interactions with industry. Through these balanced partnerships, the Society stands firmly on the moral ground set forth by the medical community and continues to dedicate its efforts to improving care for the critically ill and injured.