"One would be hard-pressed to find any group that is openly wined, dined, and seduced more than are physicians." That's the assertion made by Mark H. Schaffer, executive director, CME, University of Medicine and Dentistry of New Jersey in Newark in his article, "Commercial Support and the Quandary of CME," published in the Spring 2000 issue of The Journal of Continuing Education in the Health Professions. Schaffer proposes that the Accreditation Council for CME make its Standards for Commercial Support more stringent. The founding chair of the Medical Education and Communications Company Alliance, Schaffer has served in the academic and private sectors of CME for more than 16 years.

Q: Why do you suggest that ancillary social activity at CME programs be prohibited?

A: I have a real problem when you develop an educational activity, a two-hour lecture, then you give physicians 18 holes of golf or take people out on a boat. Come on, let's be serious. The [ACCME's] Standards for Commercial Support say the ancillary activity is not supposed to overshadow [the education]. If you feel your program is so weak you have to entice physicians with all this other stuff, you have a problem with your program.

I think we need to focus more on the quality of the activity and less on the quality of [ancillary] events. I'd rather put money into programming. I'd rather do 20 programs throughout the country than 10, and at those 10 spend a lot of money to attract physicians.

Q: Some CME professionals question whether there really is any harm done when physicians play golf on a company tab. Some physicians say they are perfectly capable of resisting influence. What damage do you see done?

A: The damage done is to the ethics. Why should a physician and his or her family go to Disney World on the cuff? I take my family to Disney World and it costs me several hundred bucks to go through the gate. The general public should be incensed. At some point [public advocates] are going to [pay attention]. Physicians are in the business of providing care. Maybe I'm old-fashioned, but I want them making decisions based on what they feel is best for me. I do think the majority of physicians make their decisions based on clinical need--not on whether the company is treating them to a lavish meal. Pharmaceutical companies are probably wasting a lot of money.

Q: Some providers feel they have limited control over pharmaceutical companies' ancillary events.

A: Providers have a lot of control as long as they take it. We're not going to win any popularity contest. I've walked down the halls and heard people say, "Here comes the CME cop." You have to dig your heels in and say, "No, that is wrong." It's not an easy thing to do, especially when you are confronting a powerful chairman of a department at a medical school who brings in hundreds of thousands of research dollars. You have to say, "We can't do this big elaborate thing." Or, "You can do that big elaborate thing, but you must charge people for it."

A friend of mine at another institution walked into a really problematic situation: After CME activities everyone got to play golf. He assigned a faculty member with each foursome. There might be discussion about the activity, so in his mind it did have some educational value. He also made it clear that the reps were not part of foursomes--the reps play by themselves. I applaud him.

Q: Your stance might be viewed as surprising because you are a founding member of MECCA--and some nonprofit providers think communications companies blur the line between promotion and education.

A: With some exceptions, most of the big violations I have observed have been in medical schools, usually because they are not paying attention. One of the arguments about communications companies is that it's not their business to do education. [But] I have yet to see a medical school where CME is at the top of radar.

I used to think I was Don Quixote. Then I heard an ethicist from the American Medical Association speak. I told her, "You helped me to realize something--I'm not Don Quixote. I'm an ethicist." I don't think [enforcing medical education ethics] is an impossible dream. I think it's a doable dream.