When I heard the news from Mike Saxton, team leader and senior director of Pfizer's Medical Education Group, that his company would no longer award grants directly to medical education and communication companies, I wasn't surprised. (See story, page 22.) At the North American Association of Medical Education and Communication Companies' meeting, held during the Alliance for CME annual conference in January, Saxton and attendees had engaged in a heated debate regarding the practice used by some MECCs of employing business development personnel to seek grants, and paying them commissions based on the amount of funding they bring in.

The practice, says Saxton, creates an irreconcilable conflict of interest, providing a motivation for people to cross ethical lines in order to please grantors, and it's one of the main reasons Pfizer cut off funding for MECCs. He pointed out to me that the Code of Ethical Principles and Standards of Professional Practice, issued by the Association of Fundraising Professionals, states that people should not accept compensation of any kind tied to the dollars they raise.

Saxton's comments got me thinking about the ethical codes that include guidelines related to CME, such as those issued by PhRMA and AdvaMed. The Association of American Medical Colleges recently adopted a set of recommendations that includes tougher CME rules and a ban on pharma company gifts to physicians. What if medical education and communication companies issued their own ethics code?

Such a code could raise the bar higher than the ACCME's Standards for Commercial Support, prohibiting the business development practices that Pfizer (and no doubt other companies) are concerned about. It could suggest that MECCs have compliance officers and address other conflict of interest issues, for example, by recommending external peer review for curricula. (Watch for Jane Ruppenkamp's suggestions on this topic in our next issue).

It could also promote balanced funding, perhaps with a cap on the amount of commercial support a company should receive. MECCs are perceived to be more susceptible to pharmaceutical industry influence, in part because they receive more commercial support than any other provider type. According to the Accreditation Council for CME Annual Data Report 2006, MECCs made up 21 percent of providers, yet they receive more than half of the yearly $1.2 billion in industry funding. Commercial support accounts for 76 percent of MECCs' total income — a bigger percentage than any other group. Diversifying their funding sources would make MECCs less vulnerable to criticism.

NAAMECC has put together a set of criteria for grantors assessing providers, an excellent foundation for a code. MECCs that pledge to follow it would gain an advantage when seeking partnerships in the CME community.

MECCs might respond to this idea by saying, “Why should we?” They may feel that they have the right to run their businesses as they see fit, and as long as they adhere to the ACCME guidelines — and as a group they have an excellent compliance record — why should they be held to a higher standard?

Well, maybe because instead of going on the defensive, it might be more effective for MECCs to take a proactive, leadership position and send a strong signal that they are serious about reversing perceptions, demonstrating their independence, and remaining valuable participants in the CME enterprise.