New Standards Under Fire
Dear Editor: I read your article “Don't Relax Yet” [June issue] with great interest. As the CEO of an Accreditation Council for CME accredited sponsor that has been developing and conducting CME activities for more than 20 years, I fully understand the confusion that CME providers are experiencing with the implementation of the new Standards for Commercial Support. While relatively small and quick to read, their implications are significant for accredited providers and, in my opinion, the ACCME has once again failed in its attempt to make CME stronger and better.
First of all, these new Standards for Commercial Support are not “standards” at all. No measurable criteria are provided by these “standards” in order to evaluate whether your organization is in compliance or not. Instead of developing real, measurable criteria, the ACCME again leaves the development and implementation of these standards to individual CME providers. The problem with this is that individual CME providers will develop their own “standards” that will vary widely from accredited provider to accredited provider, causing confusion among commercial supporters, educational partners, and faculty.
Let's be honest: CME is a business with hundreds of millions of dollars changing hands and with hundreds of hospitals, universities, medical societies, and education companies all competing with each other for these funds. When the ACCME continues to provide what amounts to simple platitudes that provide no real guidance or measurable standards, it fails in its sole mission to ensure that all ACCME providers have clear instructions on how this very important business should be conducted. Without measurable standards, how is the ACCME going to determine if an accredited sponsor is adequately resolving conflict of interest, especially when the term “conflict of interest” in never adequately defined? When individual CME providers are allowed to set their own standards without adequate guidance from the ACCME, those providers with the lowest possible standards are the ones most likely to benefit.
Throughout the entire debate that has raged through the CME community in the last year regarding the draft Standards for Commercial Support, not a single voice has been heard regarding the true culprits in this whole debate — the physicians who demand exorbitant honoraria and are nothing more than hired guns for the commercial supporters with whom they have a relationship. While a great majority of the physicians who participate in CME are dedicated professionals who care deeply about the CME that physicians receive, my experience is that there is a growing percentage of physicians who make a great deal of money each year participating in both promotional and accredited programs for the pharmaceutical industry and are willing to say almost anything depending on who is supporting the activity. These new “standards” do not give accredited providers any real, measurable criteria that can be used to disqualify faculty because of conflicts of interest.
The ACCME has also failed to provide any measurable guidance on the payment of faculty honoraria. Basic guidelines for the payment of honoraria would create a level playing field and would take the pressure off of providers who are continually forced to bargain with faculty on honoraria for CME activities (“Company A pays me this amount of honoraria, why should I work for less for you?”). With all CME providers paying the same basic honoraria, commercial supporters and other nonaccredited educational partners would not find it profitable to search out the accredited sponsor with the most liberal honoraria policy but instead could concentrate on the quality of the CME provider with whom they chose to work.
My experience in more than 10 years of CME is that a great majority of CME providers want to do the “right thing.” These new “standards” offer little guidance so that we can determine what the right thing is.
Name withheld upon request
Visa Hassles
Dear Editor: Unfortunately, I cannot agree with your assessment concerning visa requirements and foreign attendees coming to U.S. conferences [“Docs Unfazed by Visa Hassles,” June issue]. Science these days is a very global game, and in our lab we host 15 people of 10 different nationalities from four continents. This is certainly not a feature peculiar to Switzerland, but is evident in all spheres of research worldwide. Even though it has been standard procedure for our team members to attend meetings in the United States on an annual basis, this may change after the recent failure of my staff to obtain visas to attend leading conferences at which they were presenting data, even though they sent in their applications well in advance of the travel date. Not only does this cause considerable expense (cancellation of flights, loss of conference fees, etc.), but it also excludes them from interacting directly with their peers. We can, therefore, only hope that the attitude towards foreign participants at U.S. conferences will change in the future to permit a ready free flow of academics and information once again.
Sinuhe Hahn, PhD
Laboratory for Prenatal Medicine
University Women's Hospital
University of Basel
Basel, Switzerland
