“This is serious. Everyone has to comply. It's coming from the top down.” That was the refrain I heard over and over while researching the cover story about the Pharmaceutical Research and Manufacturers of America's new ethical guidelines on relationships with healthcare professionals. Like many of you, I applaud the industry for taking this major step to reform the culture of ethical abuses that has dominated the relationships between physicians and pharma reps in recent years.

But these rules represent a huge transformation within the entire healthcare community. And while it's critical to have CEO level support in the pharma industry, the changes are not going to take hold without the commitment of the people on the front lines — the people who day-to-day will be struggling to do the right thing in a fast-changing, often confusing and ambiguous environment. CME providers can play a pivotal role in the code's success. It is CME providers who see all the parties in action — the physicians, medical students, and sales forces. They have a wide perspective of the complexity of those interactions.

I am so impressed with the CME providers I interviewed who are going all out to educate people about the new guidelines. People like Melinda Burdette, with Mercer University School of Medicine in Macon Ga., who distributed the code to her reps — even before they received it from their companies — and has offered to train reps about developing productive, ethical relationships with CME providers.

Barbara Barnes, MD, University of Pittsburgh School of Medicine, suggested a small, high-level group representing all the stakeholders get together in a locked room and hammer out the really controversial issues involved. That's a great idea. The CME community can form a joint committee with PhRMA that will listen — on an ongoing basis — to the voices of the people on the front lines.

Top down is great, but it does have limitations. Witness the reactions of the companies that are delaying CME funding until they figure out how to apply the code. That strategy protects the company — but can harm physician education by disempowering the field reps and CME providers and disrupting their relationships. It is their voices that must be heard, as the CME community and pharmaceutical industry collaborate to make this code a living, lasting ethic.