AT MY FIRST continuing medical education professionals' meeting, the 1997 American Medical Association CME Provider/Industry Collaboration Conference, I had a breakfast conversation that I've never forgotten. A CME provider told me how his organization worked with pharma companies to develop marketing programs for new drugs. The strategy involved producing CME activities that created cognitive dissonance — in other words, generated dissatisfaction — among physicians about existing treatments; then, the new product would be introduced as an improvement. I don't recall him saying anything about whether the new products were actually better for patients than the old ones. The strategy was about how to make physicians think that they were better so that they would prescribe them. He was describing using CME and the learning theory of cognitive dissonance to manipulate doctors.

Fast-forward to the 2005 Alliance for CME conference in January. I was struck by the difference in tone. Sessions addressing how to develop ethical collaboration between the pharma industry and CME providers were packed, as were sessions concerning the Accreditation Council for CME's updated Standards for Commercial Support. As we report in our cover story, beginning on page 26, attendees focused not only on how to follow the letter of the new rules but also discussed how to really ensure that CME is truly objective and balanced.

One of the major hurdles CME providers face is educating faculty and participants about conflict of interest. As Murray Kopelow, MD, ACCME, pointed out at the conference, physicians don't want to believe that commercial support of CME can influence their prescribing choices. Here's where cognitive dissonance — the uncomfortable feeling you get when you learn something new that challenges your current beliefs — can be put to a positive use. To ensure that CME becomes more independent, providers must create cognitive dissonance among faculty to help them acknowledge the reality that relationships with the pharmaceutical industry may — despite the best of intentions — inject bias into CME.

Providers can not only help faculty question their beliefs, but encourage them to bring the issues out into the open at CME events. For instance, at an Alliance mini-plenary, CME veteran Sue Ann Capizzi proposed that providers ask CME faculty who also serve on pharma speakers bureaus to make a statement to their audiences saying that they recognize the difference between certified CME and promotional activities, that they will not use promotional materials developed by a pharma company in an educational program, and that their presentation will be balanced. Such a statement should cause faculty and participants to reflect on the potential effect of industry relationships on CME content.

Given the complex web of physician/pharmaceutical industry connections, I think it's unrealistic to believe that CME could ever be completely devoid of commercial influence, no matter what rules or regulations are put in place or where the funding comes from. But I hope that the CME community continues its dialogue about managing conflict of interest and enforcing the new regulations, and that CME professionals' efforts will eventually result in a different environment — where it is unacceptable to use certified education as a marketing tool.