nov.dec.orgs.indd A N NA L S O F FA M I LY M E D I C I N E ✦ W W W. A N N FA M M E D . O R G ✦ VO L . 7 , N O. 6 ✦ N OV E M B E R / D E C E M B E R 2 0 0 9 562 Family Medicine Updates From the American Academy of Family Physicians Ann Fam Med 2009;7:562-563. doi:10.1370/afm.1062. AAFP POLICIES ON INDUSTRY RELATIONS WELL ESTABLISHED, WELL MANAGED Many AAFP members have had questions about recent reports and opinion pieces that call on medical pro- fessionals to keep their distance from pharmaceutical companies in terms of industry support—particularly for CME. The so-called Macy Report from the AMA’s Coun- cil on Ethical and Judicial Affairs; a special communi- cation in the Journal of the American Medical Association (JAMA); and an exhaustive (and exhausting) 360-page report from the Institute of Medicine addressing “con- fl icts of interest in medical research, education and practice,” all lead members to ask, “What is the posi- tion of the AAFP regarding interactions with pharma- ceutical companies?” These reports and opinions start from a basic premise that any engagement with the pharmaceutical industry is a confl ict and must be eliminated. But the AAFP does not accept this “good money/bad money” hypothesis, and neither do most professional associa- tions. Pharmaceutical and other companies have a signifi cant role to play in informing health care profes- sionals about the availability and proper use of medica- tions and other therapies. As the nation’s fi rst recognized accreditor of CME, and as a medical specialty society with an established membership and renewal criteria requiring accredited CME, the AAFP has consistently demonstrated its dedication to supporting physicians in their obligation to learn and advance scientifi c knowledge by engaging in lifelong learning. Long experience has shown that potential confl icts of interest and relations with industry can and must be managed consistently and effectively. To the extent that an industry’s products are based on solid medical science and best clinical practices, physicians and physicians-in-training have the right and the responsibility to be trained in the appropriate use of such products so as to provide appropriate qual- ity care for their patients. The AAFP has many policies in place to manage relationships between CME providers and funders, beginning with full disclosure. In addition, the Acad- emy takes the necessary steps to create fi rewalls between content and funding and to resolve confl icts as needed. The AAFP has done this very successfully for more than 60 years. Why would the Academy sud- denly believe that this approach is insuffi cient? Is there evidence? To the contrary, a study performed by the Accredi- tation Council for Continuing Medical Education, or ACCME, in 2007 demonstrated that there is no dif- ference in the level of bias between pharmaceutical company-funded CME and nonfunded CME, as long as the CME is accredited according to the ACCME Standards for Commercial Support. The AAFP continues to build on its belief in trans- parency by undertaking additional steps to resolve confl ict. For example, • staff members are working to ensure that the AAFP's confl ict of interest forms for leaders and CME are standardized, consistent, and clearly understood • the AAFP is enhancing its faculty database reporting and searching functionality to prepare for organization-level reporting of faculty with industry relationships • faculty and staff members involved in AAFP CME are expected to complete the educational National Faculty Education Initiative program offered by the Alliance for CME and the Society for Academic CME that clarifi es the differences between promotional and educational activities • the Academy is pursuing ways of incorporating patient, practice, and clinical data into the needs assessment and outcome evaluation of AAFP-pro- duced CME Each of these initiatives demonstrates that the AAFP is committed to a model of continuous process improvement in the quality of the CME it provides. In the interest of full disclosure, the AAFP does receive funds from pharmaceutical companies for an array of activities, from advertising in its journals to exhibits at the annual Scientifi c Assembly to grants for CME. When you extract the fi rst 2 categories, as the JAMA article recommends, the AAFP’s level of pharmaceutical industry funding is 11%, which is well below the “acceptable threshold” of 25% proposed by the authors of the JAMA article. In addition, Academy staff members go to great lengths to keep the Board of Directors, commission members, and the Congress of Delegates apprised of all A N NA L S O F FA M I LY M E D I C I N E ✦ W W W. A N N FA M M E D . O R G ✦ VO L . 7 , N O. 6 ✦ N OV E M B E R / D E C E M B E R 2 0 0 9 563 FA M I LY M E D I C I N E U P D AT E S the Academy’s funding activities, particularly the rela- tionships the AAFP has with pharmaceutical companies. The AAFP has confi dence in the structure that it and others have put in place over the years, includ- ing the ACCME’s Standards for Commercial Support, which are designed to ensure and reinforce indepen- dence in CME activities. The Academy also has a high degree of confi dence in the ability of the overwhelm- ing majority of our 94,000 members to know right from wrong and to refuse to let their professional judg- ment be infl uenced by trivial contacts that some indi- viduals and government types now seek to criminalize. If industry support is lost or reduced, who will pay for continuing medical education? Two words—physi- cians will. Individual learners or organizations, such as the AAFP, already pay more than 50% of CME costs, but the burden will have to shift even more. That may be fi ne for physicians in academic medical centers, but it will be an added stress on family physicians in clini- cal practice. In fact, we could be headed for the worst of both worlds if less CME is available to practicing physicians and more funds are shifted to promotional spending, such as direct-to-consumer ads. The AAFP supports a heightened sense of profes- sionalism in industry relations, which could be a good outcome of this current debate. And the organization reaffi rms its pledge to promote high-quality, innova- tive education for physicians, residents and medical students that will improve professional practice and patient outcomes and encompass the art, science, evi- dence and socioeconomics of family medicine. “As We See It: Voices of the AAFP” Staff From the American Board of Family Medicine Ann Fam Med 2009;7:563-565. doi:10.1370/afm.1063 2009 PISACANO SCHOLARS The Pisacano Leadership Foundation, the philan- thropic arm of the American Board of Family Medicine (ABFM), recently selected its 2009 Pisacano Scholars. These 5 medical students follow in the footsteps of 71 scholar alumni who are practicing physicians and 15 current scholars who are enrolled in family medicine residency programs across the country. The Pisacano Leadership Foundation was created in 1990 by the ABFM in tribute to its founder and fi rst executive director, Nicholas J. Pisacano, MD (1924–1990). Each Pisacano Scholar has demonstrated the highest level of leadership, academic achievement, communication skills, community service, and character and integrity. Bethany Enoch, a 2009 Pisacano Scholar, is a 4th-year medical student at the University of Kansas School of Medicine. She graduated summa cum laude from MidAmerica Nazarene University with a Bach- elor of Arts in Biology and Music Performance. As an undergraduate, Bethany received a number of honors and awards, including the President’s Award, a half- tuition scholarship based on ACT scores. As a medical student, Bethany has continued to receive numerous awards and has achieved signifi cant leadership positions. At Kansas, she served as the president of the Family Medicine Interest Group and the vice president of the Kansas Alpha Omega Alpha chapter. Bethany also served as a student representa- tive to the Kansas Academy of Family Physicians Board of Directors, and at the national level was elected as the student chair of the American Academy of Family Physicians’ National Conference of the Family Medi- cine Residents and Students. After moving to Kenya at the age of 10 with her parents who became missionaries, and witnessing the disadvantages that so much of the world endures, Beth- any decided in 6th grade that she wanted to become a doctor. At a very young age, she served children of AIDS victims who were living in orphanages and deliv- ered food and blankets to victims of tribal violence near her school. Bethany is confi dent that her experi- ence as a child is what led her to medical school. As a doctor, Bethany plans to provide full-spectrum care from delivering babies to providing end-of-life care. She plans to be active in her community and work for her patients by helping to implement healthy measures in the community. Pamela Ferry, a 2009 Pisacano Scholar, is a 4th- year medical student at Baylor College of Medicine. A National Merit Scholar, she graduated from Stanford University with a Bachelor of Arts in Human Biology. She also received a Master of Health Science with a major in International Health from Johns Hopkins University. As a Liberty Hyde Bailey fellow at Cornell University, Pamela completed doctoral coursework for her PhD before deciding to pursue her medical degree. From 1992-1996, Pamela served as a missionary with the Mennonite Central Committee in Yapacani, Bolivia working as a regional coordinator and health educator. After returning from Bolivia, Pamela joined Baylor, where she is currently the assistant director for the Center for Educational Outreach and assistant professor of Allied Health Sciences. Pamela was instru- mental in the development of the Texas Joint Admis- sion Medical Program (JAMP), which is now a well << /ASCII85EncodePages false /AllowTransparency false /AutoPositionEPSFiles true /AutoRotatePages /All /Binding /Left /CalGrayProfile (Dot Gain 20%) /CalRGBProfile (sRGB IEC61966-2.1) /CalCMYKProfile (U.S. Web Coated \050SWOP\051 v2) /sRGBProfile (sRGB IEC61966-2.1) /CannotEmbedFontPolicy /Warning /CompatibilityLevel 1.4 /CompressObjects /Tags /CompressPages true /ConvertImagesToIndexed true /PassThroughJPEGImages true /CreateJDFFile false /CreateJobTicket false /DefaultRenderingIntent /Default /DetectBlends true /DetectCurves 0.0000 /ColorConversionStrategy /LeaveColorUnchanged /DoThumbnails false /EmbedAllFonts true /EmbedOpenType false /ParseICCProfilesInComments true /EmbedJobOptions true /DSCReportingLevel 0 /EmitDSCWarnings false /EndPage -1 /ImageMemory 1048576 /LockDistillerParams false /MaxSubsetPct 100 /Optimize true /OPM 1 /ParseDSCComments true /ParseDSCCommentsForDocInfo true /PreserveCopyPage true /PreserveDICMYKValues true /PreserveEPSInfo true /PreserveFlatness false /PreserveHalftoneInfo false /PreserveOPIComments false /PreserveOverprintSettings true /StartPage 1 /SubsetFonts true /TransferFunctionInfo /Apply /UCRandBGInfo /Preserve /UsePrologue false /ColorSettingsFile () /AlwaysEmbed [ true ] /NeverEmbed [ true ] /AntiAliasColorImages false /CropColorImages false /ColorImageMinResolution 300 /ColorImageMinResolutionPolicy /OK /DownsampleColorImages true /ColorImageDownsampleType /Bicubic /ColorImageResolution 150 /ColorImageDepth -1 /ColorImageMinDownsampleDepth 1 /ColorImageDownsampleThreshold 1.50000 /EncodeColorImages true /ColorImageFilter /DCTEncode /AutoFilterColorImages true /ColorImageAutoFilterStrategy /JPEG /ColorACSImageDict << /QFactor 0.76 /HSamples [2 1 1 2] /VSamples [2 1 1 2] >> /ColorImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000ColorACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /JPEG2000ColorImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /AntiAliasGrayImages false /CropGrayImages false /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 150 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict << /QFactor 0.76 /HSamples [2 1 1 2] /VSamples [2 1 1 2] >> /GrayImageDict << /QFactor 0.15 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000GrayACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /JPEG2000GrayImageDict << /TileWidth 256 /TileHeight 256 /Quality 30 >> /AntiAliasMonoImages false /CropMonoImages false /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 300 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict << /K -1 >> /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False /Description << /ENU ([Based on '[High Quality Print]'] Use these settings to create Adobe PDF documents for quality printing on desktop printers and proofers. 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