Let's face facts. The CME enterprise is in a funk about commercial funding and the potential for biased content. We're running scared, and it shows in our chaotic search for solutions.

Consider a few recent proposals:

• Change CME program, department, or corporate structure to show that an accredited provider is legally separated from any other affiliated organization that receives funding from pharmaceutical manufacturers.

• Eliminate the business development title for CME provider employees responsible for identifying educational gaps and seeking CME grant funding.

• Disqualify some education providers from receiving additional pharmaceutical CME grants, because these providers receive “too much” of their revenues from commercial interest grant funding already.

• Eliminate commission-based compensation for employees who seek grants for certified education.

• Scrap pharmaceutical CME grant funding altogether.

A few proposals address content validity. Others address perceptions. Before we move forward with any proposal, we should ask ourselves if the fix merely substitutes action for actual leadership.

Put Down the Scalpel

When it comes to the health of the CME enterprise, we're demanding multiple surgeries before we've examined the patient's risk factors and test results. CME does not demand triage. Let's put down the scalpel, step outside the ED, and analyze the success of the current treatment regimen in eradicating content bias.

First, we have the funders themselves. Most of them have set up significant grant-review systems, independent selection committees made up of several education and scientific stakeholders, and oversight functions that include compliance officers. In addition, the legal and ethical clauses in a grant letter of agreement require scientific accuracy and resolution of conflicts of interest.

The second line of therapy to combat content bias comes from accredited providers. All CME providers (university, hospital, medical education company, professional society, and state medical society) are in the education business. When the viability of a business depends on maintenance of accreditation, an organization can choose either to abide by the rules or go out of business.

The success of our collective efforts to combat bias depends on the Accreditation Council for CME's enforcement of rules. Last year's staff report from the U.S. Senate Finance Committee didn't seek to eliminate the ACCME or its guidelines, standards, and policies. The report called for improvements to monitoring and enforcement, something the ACCME is beginning to address.

The ACCME has much work to do to fairly implement and enforce standards, policies, and definitions across all provider types. With our involvement, the ACCME can demonstrate that providers who operate by the rules eliminate bias.

Demonstrate Our Value

All CME stakeholders ought to assist the ACCME in highlighting the link between healthcare improvements and CME activities. After all, reductions in heart attack risk are partly due to statins and emerging therapies and partly due to the thousands of CME activities that educated primary care physicians and specialists about diagnosis and treatment.

The opportunity to demonstrate the value and success of the CME enterprise is right in front of us. We have a lot of work ahead, but one thing is for sure. Without leadership, the prognosis is grim.

Stephen M. Lewis, MA, is president of the Institute for Continuing Healthcare Education in Philadelphia. Reach him at slewis@iche.edu.