James G. Ramsay, MD
President, 2005-2007

President's Message

SCA Meetings: Disclosure and Management of "Conflict"

As a provider of continuing medical education (CME) accredited by the Accreditation Council for Continuing Medical Education (ACCME) in the United States, the SCA must adhere to "Standards for Commercial Support" as defined by this organization. The mission of the ACCME is "the identification, development, and promotion of standards for quality continuing medical education utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities." Our society's ability to provide CME credits, essential for our members, is critically dependent on our accreditation by the ACCME. In September of 2004 the ACCME adopted new standards to ensure the independence of CME activities from commercial interests. These new standards require an entirely different level of management of all speakers and presenters at all our meetings, compared to the previous standards. The standards must be met by every accredited provider of CME credits in the United States. In the following paragraphs I will outline how the new standards affect speakers and presenters at our meetings. The key concepts are: disclosure of conflict, management of conflict if it exists, and monitoring to be sure management has indeed been effective.

"Disclosure"

While disclosure of conflict of interest (that is, disclosure of any relationship with a commercial entity which a speaker might have, related to the presentation) is not a new concept, the ACCME now requires that anyone who has control over the content of an accredited CME activity must disclose any conflict within the previous 12 months. Also new: if a conflict is identified it must be "managed" as described below. I would like to highlight four important implications of this new disclosure standard. First, the SCA Board of Directors selects the scientific program chairs for all SCA meetings, therefore the SCA Board as well as the program chairs and their committees must all disclose. Second, because conflict must be "managed" we have empowered the SCA Ethics Committee to review all scientific programs at an early stage, in order to identify potential conflicts with topics/speakers as they might be related to the program committee members. Third, because management of conflict is required, disclosure must occur well before the meeting (eg at the time a speaker/presentor accepts an invitation). Disclosure from the podium is only acceptable as an "exception" such as a last-minute speaker replacement. Fourth, because scientific sessions (abstract and poster sessions) are included in CME time for the meeting, presenters of abstracts and posters must also disclose.

"Management of conflict"

Once conflict appears to be present, the SCA must manage the conflict to ensure independence of the presentation from commercial interests. The most "draconian" solution is to select a different speaker without conflict, but this is not a realistic solution - we all want to hear from the leading investigators in our field, and many will have commercial ties of some kind. Some management options suggested by the ACCME include (a) requesting the speaker to avoid areas where he/she may have conflict; (b) requesting the speaker to only cite "evidence-based reviews" when discussing areas where conflict exists, and (c) having a member of the scientific program committee review the presentation before it is given, and make recommendations about changes to the presentation or individual slides in order to eliminate bias. Of course each of these options has its limitations. The ACCME is not unrealistic in its expectations, but they do require that we make a reasonable effort to manage conflict once it has been identified, and that we do so before the educational activity.

"Monitoring"

The final part of the new guidelines requires ongoing monitoring of our presentors for bias, and a plan for action should bias be detected. While we have already been asking our audiences regarding this, we have implemented a policy where a member of the scientific program committee for the meeting must monitor every session and evaluate each presentation for the presence of commercial bias. These evaluations will be used, in addition to the audience evaluations, to determine if a speaker will be eligible to present at future SCA meetings. The new standards for commercial support are available in detail at the ACCME website (www.ACCME.org); I encourage each of you to spend a few minutes to read the section entitled "Standards for Commerical Support." Not only are the main activities of every SCA meeting affected; industry-sponsored sessions fall under the same guidelines if CME credits are to be provided. Due to the requirements for documentation, it will be very difficult for the SCA to provide CME credits for meetings where we are a "co-sponsor," such as international meetings; indeed, for this reason we are not offering CME credits for next year's meeting in Prague. We now have an additional layer of work and monitoring added to the already considerable voluntary efforts made by our dedicated members who organize and present at our meetings. Similarly, the requirements for documentation and monitoring add a significant burden to our management company (Ruggles Service Corporation) and members of the Board who must participate in ACCME audits/reviews. The "up" side is that these new processes will undoubtedly lead to greater independence of our CME activities from commercial interest, which is the goal of the ACCME.

James G. Ramsay, MD
President, SCA


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