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Conflict of Interest in Medical Research, Education, and Practice
Responses to Concerns About Bias in Industry-FundedAccredited Continuing Medical Education
Responses by Private Organizations
Expanded industry support for accredited continuing medical education and the involvement of commercial firms began to become a significant concern in the 1980s and led to ACCME-developed guidelines on commercial support in 1987 and then ACCME-developed standards in 1992. These standards have been criticized as doing little to curb industry influence over the content of accredited continuing medical education (see, e.g., Relman [2001, 2003]; see also Ross et al. , Krimsky , and Brody ). In 2004, ACCME issued new, more restrictive standards.
The accreditation standards now require the disclosure of conflicts of interest by meeting planners as well as speakers. They also require the review of the educational content for bias and the resolution of conflicts of interest in some fashion (e.g., by finding an alternative speaker or identifying and eliminating biased content in a presentation). In addition to the standards, ACCME has developed tools (e.g., definitions, frequently asked questions, and slide presentations) to help educational providers with program implementation.
The SACME survey mentioned above reported that academic providers found the 2004 standards to be difficult to implement (SACME, 2007). Only 5 percent of the respondents considered the standard related to resolving conflicts of interest to be easy to implement. Slightly less than half of the respondents thought that the standards had reduced bias a little or somewhat.
In 2008, the ACCME board of directors adopted a statement that indicated that accredited continuing medical education providers “cannot receive guidance, either nuanced or direct, on the content of the activity or on who should deliver that content” (ACCME, 2008b, p. 3). The organization also announced that it was devoting more resources to implementation and enforcement, which would eventually require an increase in member fees (ACCME, 2008b). In addition, ACCME issued a request for comments on a proposal related to commercial support, which included as options the elimination of commercial support, the continuation of the current situation, and the development of a new paradigm (ACCME, 2008d). The executive summary for the November 2008 board of directors meeting states that analysis of the comments is continuing and that action is not anticipated before the end of 2009 (ACCME, 2008c).
Notwithstanding the changes in ACCME standards, criticisms of industry funding and influence continue (see, e.g., Steinbrook [2005, 2008b] and Fletcher ). ACCME’s limited resources for monitoring adherence to