As I began putting this issue together, I kept thinking about thresholds and transitions, the places and spaces we have to visit while traveling between where we have been and where we're going. This isn't just because this is my first issue as' editor, though that's part of it. Coming back to Medical Meetings as editor after having been away for a few years has felt a little like that Little Feat song about having one foot on the platform and other on the train — and did I mention that the train is the Acela Express going 100 mph? And that our trustworthy engineer, Tamar Hosansky, has left the station to join the Accreditation Council for Continuing Medical Education as director of communications?
But, since this isn't all about me, it quickly became apparent as I dove into this issue's articles that both continuing medical education and the pharmaceutical industries are in that transition state as well. Our cover story outlines some of the changes coming down the track in terms of state laws being enacted to curb pharma influence over physicians, and how that could affect the CME and commercial support communities. The's proposals regarding new designations for commercial-support-free CME programs and speakers, new ways of funding CME, and even changes in the way the ACCME determines its policies and procedures indicate it's in that state of flux as well. And it likely will be for some time, as will everyone involved in CME and pharma as more state and federal laws are debated, and perhaps enacted.
It's an unsettling feeling, being in that liminal space. All bets are off. While the old rules still count, it's easier to question authority when that authority is in transition. In its definition of liminal, Wikipedia says, “The liminal state is characterized by ambiguity, openness, and indeterminacy. One's sense of identity dissolves to some extent, bringing about disorientation. Liminality is a period of transition where normal limits to thought, self-understanding, and behavior are relaxed — a situation which can lead to new perspectives.”
That last bit is where I find a great sense of hope, and excitement, amid the uncertainty. That ACCME is making what for the Council is radical proposals tells me that it is looking at the business it regulates with a new eye — whether you love or hate what it is coming up with, I think ACCME should be applauded for looking for new ways to shape the face of CME. As should the legislators who are taking it on, though they do need your guidance to come up with laws that will improve physician education without first doing some serious harm. Watching the boundaries dissolve between past and future and somehow coming up with the guts to take the leap into the unknown is not for the faint of heart. Good thing I know you are up for the challenge.
Speaking of a challenge … Now that the pressure is really on to kick the commercial-support habit — witness the new Institute of Medicine report, Conflict of Interest in Medical Research, Education, and Practice; new state laws, most recently in Massachusetts, around pharmaceutical marketing; and an increasingly vocal group of healthcare leaders who are lobbying for reform — how should CME be funded? We know that docs don't want to bear the full burden. The ACCME's proposal to create an independent third party to collect and disseminate pharma funds didn't seem to garner a lot of support. While it would take the pressure off, I seriously doubt we'll see public funding of CME in our lifetimes. So what will CME funding look like in five years? in 10? If your crystal ball is any less cloudy than mine, e-mail me your thoughts.