Cost of a Free Lunch

The ACR’s annual meeting serves many purposes. First and foremost, it is the premier scientific meeting in rheumatology—a chance for those of us in academia to come together in one place to exchange ideas, develop collaborations, and plant the seeds of new investigations. It is also a chance for us to see and be seen, hopefully impress our colleagues with our newest research, and gossip about who is doing what.

For clinicians (by far the largest group in attendance) the meeting is an opportunity to discover the cutting edge of research and review and consolidate their understanding and approaches to therapy of rheumatic diseases. For everybody who attends, the meeting is also a social occasion—a chance to see old friends who share an interest in rheumatology but who are geographically distant from you.

Influence for the Price of Chow Mein

Among the many old friends whom I saw in Washington last November was someone who had left academia for employment at a pharmaceutical company. We chatted in the halls of the convention center and had an opportunity to have lunch together at one of D.C.’s fine restaurants.

At this lunch, I did something that was highly unusual for me and certainly for the attendees of the ACR meeting: I picked up the check. It is not often that I have the opportunity to subsidize the pharmaceutical industry or influence an employee of major pharma, although I readily admit that lunch in D.C.’s Chinatown doesn’t make much of a dent in anybody’s budget. Nonetheless, by the logic of the people in charge of continuing medical education (CME), I could be exerting undue influence on this pharmaceutical employee because even the smallest gift (e.g., a pen) carries more than token influence. Fortunately for my friend in pharma, I didn’t intend to fill out any disclosure forms or put up a slide disclosing our lunch at his next presentation to management.

Clearly, the bulk of the advertising and promotion funds spent by pharmaceutical companies is directed at physicians, and the industry must think that it is getting value for its money. Much of the pharmaceutical funding goes to supporting CME events for physicians, and the majority of outside speakers who visit any institution are funded, at least indirectly, by pharmaceutical company donations. Moreover, from the Frank Netter illustrations that were used widely when I was a medical student to the PowerPoint images used by many medical-school lecturers today, basic teaching materials have also emanated from the pharmaceutical industry. Thus, the continuing education of clinicians, evidence for which is a condition for licensing and renewal of hospital privileges, is highly subsidized by the pharmaceutical industry. Critics of this system often seem aghast because the continuing education system for physicians could be susceptible to disguised (and not-so-disguised) commercialism.

Regulatory Burden on CME

In response to the potential for abuse inherent in this system, the Accrediting Council for Continuing Medical Education (ACCME), the accrediting body for continuing medical education, has developed a series of regulatory requirements that govern the provision of CME. Not least of these requirements is that all presentations be vetted for undue pharmaceutical company influence. According to the ACCME, speakers must make a full disclosure of any potentially conflicting commercial interests prior to any presentation.