ALLIANCE FOR CME TURNS 25 The Alliance for CME celebrated its 25th anniversary annual conference in New Orleans--what better place for a party? Held January 19 to 22 at the Hilton New Orleans Riverside, the conference attracted a record 1,327 attendees.

In three plenary sessions, speakers observed how medical practice has changed over the past 25 years and forecast a revolution in health care for the future, driven in large part by advances in genetics, the Internet, and the patient empowerment movement. But despite fast-paced developments in technology and science, speakers pointed to a single theme that links CME in the past, present, and future--patient care. CME providers need to help physicians improve their communication skills and refocus on healing the patient's spirit as well the physical disease.

Changing Rules *The Accreditation Council for CME apprised attendees of two relatively new rules regarding disclosure: Providers must inform physician learners when faculty members have nothing to disclose or when they have refused to disclose. "Both of those are very different," said Kathleen Regnier, associate executive director, ACCME. "but they are very valuable, the ACCME believes, in [ensuring that physicians] are "informed learners."

*The American Medical Association announced new policies regarding Category 1 AMA Physician's Recognition Award credit. While these new rules don't directly apply to CME providers, as the AMA will award the credit, the AMA wanted to apprise providers so they could answer physicians' questions. The AMA will now award credit for the following activities: articles published in peer-reviewed journals, poster preparation for an exhibit at an accredited meeting, training and lecturers, specialty board certification and maintenance of board certification, and medically related degrees such as the Masters in public health.

"We are working on more revisions that will recognize and reward physicians' self-directed learning," said Arthur Osteen, PhD, director, office of physician credentialing, AMA.

More conference coverage begins on page 36.

Great Expectations PATIENCE WITH PATIENTS If there was one message that emerged most strongly from the Alliance for CME Annual Conference, it was that health care providers must learn to give patients the intangible aspects of care--such as empathy and compassion. Here's an educational tool that can help. Susan Keane Baker's Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients, offers a range of low-cost, practical strategies to assist practitioners in building stronger relationships with their patents--everything from how to conduct patient surveys to the timely issue of dealing with physician error.

Baker has spoken to numerous groups including the American Association of Occupational Health Nurses, Inc. You can contact her at (203) 966-4880. Her book is available for $34.95 through Jossey-Bass Publishers at (800) 956-7739; www.josseybass.com.

Inspiring Women SAN FRANCISCO WOWS PCMA "To women, I say you must keep climbing because our most difficult climb is now." It was a fitting entreaty by NBC news anchor and senior analyst Ann Curry, who opened the 44th annual meeting of the Professional Convention Management Association, held in San Francisco at the Moscone Convention Center. Curry's story of the challenges she faced in her career touched many in the audience and resonated especially with PCMA's new chairwoman, Jean O'Donnell, director of meetings for American College of Physicians- American Society of Internal Medicine, Philadelphia.

"I felt as if Ann Curry and I had similar challenges, and I related to everything she said as if I'd known her for years," O'Donnell says. "What an inspiring speech for all of us."

The January meeting drew a record 3,115 attendees, and San Francisco threw out the welcome mat in a big way for PCMA attendees with a spectacular reception at Mayor Willie Brown's "house," the magnificently renovated City Hall. Three floors surrounding the rotunda and a staircase that would dwarf the one in Gone With the Wind were transformed into the neighborhoods of San Francisco and offered all of the food and libations--dim sum from Chinatown, shrimp from Fisherman's Wharf, martini bars from Nob Hill--that make the city famous.

On the business side of the event, sessions on third-party housing, contracts, attrition, citywide meetings, liability, and post-convention reporting packed conference rooms, but the power of Web-based technology and concern about the infiltration of for-profit venture capital into the association domain was evident across the board.

Cheryl Russell, who is director of conventions and meetings for the American Speech-Language-Hearing Association, Rockville, Md., warned planners in a crowded session, "Virtual Meeting Communities," that associations must be on guard for Internet competition. Russell's case-in-point: In November, "10 doctors put some money together and created a virtual association, radiology.com. Within months they had thousands of members. This is definitely competition for associations." (MM June will feature in-depth coverage of virtual medical associations and e-CME.)

In other PCMA news, the organization's Chicago headquarters will open by year's end in McCormick Place's Lakeside Center. The move will give PCMA 3,600 square feet of space in the new McCormick Place Conference Center, now under construction.

PCMA Picks DuBois The wait is over. After nine months of searching, the Professional Convention Management Association (PCMA) Board of Directors tapped a former employee to replace President and CEO Roy B. Evans Jr., who will retire June 1. David DuBois, who served as a senior vice president with the organization from 1991 to 1995, will take the helm on April 1.

According to PCMA Chairwoman Jean O'Donnell, "Dave brought the most of all the things we needed to the table," she says, "and a good understanding of our organization. We are thrilled to have Dave back as a member of our team."

DuBois is the current COO of Dallas-based Meeting Professionals International, and prior to that, he held sales and marketing positions with the Sheraton and Ritz-Carlton Hotel companies. DuBois was chosen from about a dozen candidates from inside and outside the industry.

Global Memories CME CROSSES BORDERS We asked readers to send MM their highlights from the Alliance for CME's Annual Conference. Here's a comment that points to a growing trend in CME--globalization.

"I would have to say that a turning point in my own career with CME is having the opportunity to be involved on the international committee meeting at the CME Alliance conference in New Orleans. It is very exciting to be a part of this group. One of the goals of this committee is to reach out in a national, European and worldwide context and develop policies for international accreditation," said Celene Chasen, manager of corporate relations, Baylor College of Medicine, Houston, Texas

For more information, contact Chasen at (713) 798-4024 or cchasen@bcm.tmc.edu.

For more education about global CME trends and opportunities, consider attending the Fifth Annual GAME (Global Alliance for Medical Education) conference, scheduled for June 25 to 27 at the Princeton Club in New York. Cost is $295 for members; $445 for nonmembers. For more information, call (203) 662-9690, or visit www.game-cme.org.

PRESCRIPTION "WE WOULD DO IT AGAIN IN A MINUTE," says Lisa Schleelein, CME, and director of CME at the Ithaca Center for Postgraduate Medical Education, Inc., of Ithaca, N.Y.

The Ithaca Center's recent site survey for re-accreditation with the Accreditation Council for Continuing Medical Education (ACCME) in Chicago was conducted long distance, via video.

Televideo surveys work like this: ACCME refers you to a videoconferencing company. In Schleelein's case, it was V-Span (www.vspan.com), a bridging service provider that handles the technical aspects and lends its expertise. ACCME also suggests a venue. Schleelein took its recommendation, holding the televideo survey at nearby Cornell University.

The video site survey method saves travel time and costs--a big selling point for Schleelein. "When the bill came, it was so reasonable," she says.

Schleelein offers these tips to other CME providers:

* When choosing a broadcast site, pick an environment that reflects the organization. "Our facility at Cornell was great," Schleelein says, "but the basic room was outdated--the drapes were from the 1950s--and these things do have an effect. You don't want to look like a fly-by-night operation, but you don't want it too glitzy either."

* Do a dry run at the broadcast site. Schleelein had never seen herself on live television and it can be a nerve-wracking experience. Details such as the colors you wear, your hand gestures, and where you place your microphone all affect the overall delivery.

* Review your accreditation application page by page, and quiz one another. Schleelein says, "If you have an opening presentation, rehearse it."

* Always have a backup plan, such as an alternative date. "There was a fire in the building the day of our broadcast," she says. "It was only smoke caused by a fan and we were just a little late."

As with anything else, there are disadvantages to consider. "If you're concerned about the loss of personal contact or if you have a new facility to showcase, you might want to have the surveyors come to you," Schleelein says.

Practice Makes Perfect When gearing up for a televideo site survey, the best advice from Lisa Schleelein, MEd, CME, and director of CME at the Ithaca Center for Postgraduate Medical Education: Practice.

Just as with any live television broadcast, it pays to be prepared, she says. Rehearse the script, and don't let technical glitches break your concentration.

Breaking Barriers CUBA HOSTS U.S. MEDICAL TRADE SHOW For the first time in almost 40 years, Cuba hosted a U.S. trade show, and the event went off "without any glitches," says organizer Peter W. Nathan, CEM, president, PWN Exhibicon International, L.L.C., Westport, Conn. Held at the PABEXPO Center in Havana, January 25 to 29, the U.S. Healthcare Exhibition attracted 8,000 attendees and 97 exhibiting companies.

On the surface, the timing couldn't have been more nerve-wracking, with the Elian Gonzalez controversy making headlines. Although a few exhibitors did pull out, overall the situation worked in his favor, says Nathan. Cuban officials, who had been cooperative all through the planning stage, went "overboard," Nathan says, because they wanted to keep politics and business separate. Cuban officials facilitated every aspect of the show, Nathan says. "There were no hold-ups in customs, nothing got lost," he says. Officials cleaned and refurbished the entire convention center and threw a reception for exhibitors. Nathan used four hotels for the show, and reports that all are "absolutely terrific, beautiful, and well-managed."

Exhibitors judged the show successful, Nathan says. Not only did U.S. companies have the opportunity to make contacts and build brand awareness, but officials on both the Cuban and U.S. sides cleared away several logistical barriers to trade. For instance, initially companies were told that to process orders, they had to ship back products to the U.S. following the exhibition, and then send them to Cuba.

Instead, says Nathan, "we were able to find a warehouse in the duty-free zone, where exhibitors could send their products and keep them there while they got a new license, which saved them the cost of shipping back here and to Cuba again. The cooperation we got from so many different sources was really quite outstanding."

Nathan sees the show as just the beginning of U.S./Cuba relations concerning health care. Following the exhibition, exhibitors donated $750,000 worth of equipment to Cuba.

"Cubans like American products. They want to see more medical shows from the U.S. and an end to the embargo," Nathan says. "I'm assuming the trend will now continue."

Nathan plans to bring back his show in two years. Meanwhile, he hopes to bring an American group to Cuba's international health care show in 2000. Though his show was not a moneymaker, Nathan deems it a success because it came away with no out-of-pocket losses. "It's a first time effort, so I'm ahead of the game," he says.

CORRECTIONS NOTED *In the December 199 issue of Medical Meetings, page 31, Sue Ann Capizzi's title should have been COO, American Board of Psychiatry and Neurology, Deerfield, Ill. The executive vice-president and CEO is Stephen C. Scheiber, MD.

*In the January/February 2000 of Medical Meetings, page 17, Quotables should have been attributed to Henry Slotnick, Phd, PhD, Professor of Neuroscience, University of North Dakota in Grand Forks.

Dare We Hope? INDUSTRY TAKES ACTION ON ACCEPTED PRACTICES Quoting hockey great Wayne Gretsky and vowing that she's "not retiring until it's done," Mickey Schaefer, CAE, long an advocate for meeting industry best practices, reported on headway made by the Convention Industry Council (formerly Convention Liaison Council) regarding the industry's APEX (Accepted Practices for Excellence Exchange) initiative.

Schaefer, vice president, membership, meetings and conventions and administration, American Academy of Family Physicians, gave a status report on CIC's efforts during PCMA's annual meeting in January. Schaefer, who spearheaded APEX, served as PCMA president in 1998.

The first target is terminology, Schaefer says, the least controversial of the seven areas targeted, which include contracts, housing, and post-con reports. With a financial commitment from the PCMA Foundation--$30,000 a year for the next five years--letters have been sent to CIC's 26 member organizations asking for nominees to serve on an accepted practices commission. Schaefer hopes that key industry leaders will "catch the passion we've caught" and pass it on to others.

Will the various meeting industry players adopt the best practices?

"We don't want to push this down people's throats," Schaefer explained, "but like Wayne Gretsky said, 'You miss 100 percent of the shots you don't take.'"

Balancing Act FDA TURNAROUND In an apparent reversal of its previous stance concerning promotion of off-label uses of drugs and devices, the Food & Drug Administration told the U.S. Court of Appeals during a January hearing that it would no longer rely on its CME Guidance or the FDA Modification Act to prosecute drug companies. FDAMA sets boundaries curtailing drug companies' distribution of materials about off-label uses. The CME Guidance's 12 rules are designed to ensure that company-supported educational activities are non-promotional and free from industry's influence.

In response, the appellate court voided an earlier court decision blocking FDAMA and also dismissed the FDA's appeal of that ruling. The appellate court ruling is deemed a partial victory for pharmaceutical companies, which now have more leeway in disseminating information about off-label uses, but the case is fraught with ambiguities for all players in the medical education arena.

While the FDA's view is described as "unclear," even by the appellate judges, it seems that the FDA now considers FDAMA and its CME Guidance to be "safe harbors." According to the judges, the FDA's current position is that "if a drug manufacturer wishes to suggest content to a CME program provider in a manner that runs afoul of all the Guidance's 12 factors, that by itself is not a violation of the law."

In the initial case against the FDA, brought by the Washington Legal Foundation, a nonprofit organization that fights government regulation, U.S. District Court Judge Royce C. Lamberth ruled that FDA regulations prohibiting drug companies from disseminating information about off-label uses were a violation of the manufacturers' commercial speech rights. The FDA could not forbid manufacturers from distributing articles or books about off-label uses, Lamberth ruled, or from suggesting content or speakers to independent CME providers. That injunction still stands as law.

However, during the recent hearing, the FDA did not clarify under what circumstances it would challenge a meetingor enduring materials. (FDA spokespeople did not return our calls.)

Uneasy Relations David G. Adams, partner with the Venable Law Firm, Washington, D.C., used to work for the FDA and is now in private practice representing biomedical companies. He is advising clients to continue to exercise caution. "The companies who disseminate information outside of the safe harbors in FDAMA or the CME policy statement still do so at their own risk. I have advised companies that they're better off [dealing] with accredited programs, as those are the only kind protected by the court's decision," says Adams. He advises his clients to follow ACCME guidelines. The recent decision isn't "a license for companies to ignore the standards for accreditation. If anything, it tends to support the ACCME standards "

Ethical Dilemmas STUDY SHOWS DOCTORS' BIAS Drug Firms Spend Big Bucks on Doctors, Get Results," read the USA Today headline. The article reported on a study in the January 19 issue of the Journal of the American Medical Association, "Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?," by Ashley Wazana, MD, Psychiatry Postgraduate Education, McGill University, Montreal. Wazana analyzed 29 studies of pharmaceutical industry/physician relationships and concluded that these interactions have a negative effect on physician prescribing and professional behavior. Drug company-supported CME is biased in favor of the company's drugs, the study says.

The American Medical Association has concluded that "education [concerning the AMA's Ethical Opinion on Gifts to Physicians from Industry] is grossly inadequate," and has convened a working group to develop an educational campaign, said Dennis K. Wentz, MD, director, division of CPPD, AMA, speaking at the Alliance for CME annual conference.Wentz added that the USA Today article shows that, "We need to move into high gear," and he advised providers to remind physicians about the ethical opinion at CME sessions.

But, said one attendee, companies organize "the most lavish, outlandish activities at resorts, paying for physicians, their spouses, children, dogs, cats, maids. Where is the control on those folks?"

Physicians are supposed to follow the AMA guidelines regardless of the type of program, Wentz stressed.

(USA Today printed another story about biased medical education on March 9.)