Gifts to Physicians I take issue with Mark Schaffer's remarks on page 32 of the September/October issue, which led me to reread his article in JCEHP [The Journal of Continuing Education in the Health Professions], as well as some of the letters from physicians who responded to the Wazana review article on gifts to physicians in JAMA [Journal 2000; 283:373-380; "Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?" by Ashley Wazana, MD, appeared in the January 19th issue of the Journal of the American Medical Association.]

In answer to Mr. Schaffer's question, "Why should a physician and his or her family go to Disney World on the cuff?" I would argue, as did Steven Howard, MD, in his response to Dr. Wazana: "It is also quite cost-effective to provide perks, such as a dinner or a golf game, rather than paying physicians for the cost of their time." Whereas Mr. Schaffer makes the assertion [that] "pharmaceutical companies are probably wasting a lot of money (on ancillary social activities at CME programs)," I would argue companies would certainly be wasting resources supporting CME activities with limited attendance!

Since managed care and the pressures in today's practice of medicine are jeopardizing the traditional vacation for physicians, many now seek opportunities to combine business with pleasure. Consequently, to draw participants, many CME providers will welcome a supporting company's underwriting a resort atmosphere venue or modest social event that does not take precedence over the educational event, not unlike a specialty society's choosing to hold its annual meeting at Disney World.

As a member of the American Medical Association's Working Group on Education about Gifts to Physicians, I am sensitive to the need for CME providers and the pharmaceutical industry to collaborate and self-regulate. However, I feel the Accreditation Council for CME Standards for Commercial Support of CME are adequate when clearly understood and implemented. Mr. Schaffer could assist in that effort by more accurate interpretation of the Standards whenever he chooses to broadcast his opinions. For example, in his JCEHP article, he wrote: "Although not permitted by the Standards or related policies, speakers may (wrongfully) be paid their honoraria and expenses directly by the supporting pharmaceutical company."

On the contrary, the answer to Question #12 in the ACCME Hypothetical Questions and Answers on the ACCME Standards for Commercial Support of CME states: "The only exception is when it is impossible for the sponsor to accept grants or to directly pay a faculty member. In that case, the sponsor must document one or more compelling reasons that prevent receiving commercial funds as a grant." Moreover, the AMA Code of Medical Ethics, Opinion 8.061 states: "It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging, and meal expenses." It does not say these expenses can't be paid directly by the commercial supporter.

As an elected member of the AMA National Task Force, I take CME Provider/Industry Collaboration seriously. I am also fortunate to work with a number of accredited CME Providers who approve of companies' resources being applied to audience-building activities, since they want to attract as many interested participants as possible. In return, the attending physicians' ability to care for their patients will be enhanced. Versus Mr. Schaffer, I think the general public would be pleased.

Frederic S. Wilson Director, Professional Relations Procter & Gamble Pharmaceuticals

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