When you develop CME activities on highly publicized health problems, such as irritable bowel syndrome, erectile dysfunction, or osteoporosis, are you meeting a real public health need — or are you playing into the hands of drug company marketing strat-egists? That is the disturbing question raised by a recent article in BMJ (formerly the British Medical Journal).

The article contends that drug companies are transforming ordinary ailments into serious diseases in the minds of consumers and physicians in order to create markets for their new products. The result of this “disease-mongering,” the authors assert, is that the seriousness and risks of such health issues are overplayed, while nonpharmacologic approaches (such as weight-bearing exercise and dietary supplements in the case of osteoporosis) are downplayed. Taking more medications for more ailments translates into higher costs and more risk of drug side-effects for consumers. Most of the people we contacted dismissed the authors' claims. (See news story, page 10.) But at the risk of taking an unpopular stance, I'm going to say that the issues raised in the BMJ article are worth considering.

Although Accreditation Council for CME guidelines stipulate that providers conduct needs assessments among physicians and other sources to identify education topics, I think it's important to ask whether your CME activities do, in fact, address the most pressing health issues facing your participants and their patients. Have you ever identified a need for a topic, but not planned an activity about it because you couldn't get pharma funding? If so, perhaps you should consider alternative sources of support. (Check out our cover story, beginning on page 22.) The push toward evidence-based CME content can act as another stopgap to some of the more hidden, subtle forms of commercial influence. For instance, an article in the April 17 issue of the Journal of the American Medical Association reports that 1992 guidelines pushing hormone replacement therapy were based on soft data — observational studies and clinical experience — whereas now HRT is falling out of favor due to the evidence from high-quality clinical trials.

Partnerships between commercial supporters and CME providers are critical to CME's success. However, with so much of CME underwritten by drug companies, and when dealing with such high-stakes outcomes as patient care, it is important to question everything that you may take for granted to ensure that CME is truly independent.