The last eight years have witnessed the coming together of many groups and individuals with interest in CME in a spirit of collaboration that was previously unknown. The system needed fixing and as a result of debate, discussion, and cooperation, many positive changes resulted. ACCME, AMA, AAFP, AOA, FDA, and several other national organizations changed policy and procedure to better control and monitor the planning and delivery of continuing medical education. The White Paper would suggest that nothing worthwhile has been accomplished and that CME as we know it must be dismantled and reborn under the sole guidance of academic medical education institutions. This is wrong and, if enforced, ultimately detrimental to the education of physicians.

Many of us are not privy to why CME units in academia have not gained the respect, recognition, and funding that they deserve, but surely, elimination of for-profit, nonlicensed companies is not likely to solve these problems. They existed long before the arrival of the companies that the White Paper seeks to remove from CME. Individual CME departments need to address their specific institutional issues without suggesting that all will be well if the nonlicensed groups simply go away. Perhaps the Society can assist in the achievement of that goal.

The basic premise that only licensed medical institutions can provide legitimate CME is flawed. Do they have some exclusive right to provide continuing medical education? Would anyone challenge the educational value of the Netter Medical Illustrations as published originally by CIBA Pharmaceuticals and now by Novartis? Is the education provided by Glaxo-Wellcome via its Helix Web site not valuable? Is it fair to say that Eli Lilly is incapable of producing quality, up-to-standard CME? Are the millions of physicians who have favorably evaluated educational courses and programs offered by pharmaceutical and other nonlicensed companies misguided? Unable to judge for themselves? Inappropriately influenced? Are we also to accuse the ACCME of wrong judgment in determining that certain nonlicensed companies and groups do meet the Standards and Essentials and can, therefore, provide CME?

It needs to be recognized that nonlicensed CME providers do not operate in a vacuum. Programs are planned and staffed with the very same physicians that contribute to programs produced by their institutions. Often the institution makes the recommendation about whom to contact. Pharmaceutical and medical device companies bring great expertise to scientific development, review, and evaluation based on their extensive research and clinical programs, and they are in the unique position of having to defend their findings before government agencies. Does some form of detrimental scientific or intellectual metamorphosis take place when these same individuals participate in programs beyond the purview of the institutions? Physicians need to be given credit for integrity, scientific accuracy, and interpretive intelligence when they choose to participate in CME programs, whether institutionally or privately sponsored.

How can it be said that education produced by nonlicensed entities does not serve the public health or that these companies have concern only for profit? The pharmaceutical and device companies have made incredible contributions in diagnostics; disease prevention, treatment, and elimination; equipment; and procedures. These same companies that support CME have made enormous contributions to the public health. Profit is not a dirty word. It is what fuels scientific advances and assures through education that drugs and devices are used effectively and safely by physicians and patients.

Physicians in licensed institutions are trained in the art and science of medicine. Very few are trained as educators or in presentation or public speaking skills. As such, affiliation with an institution does not by itself bestow the advanced education capabilities which the White Paper claims to rest only within the institution. The medical institutions themselves have often publicly acknowledged that they do not have the capacity to keep pace with or to fund the demand for CME. Perhaps working and learning together is a better model for success.

A return to the "bad old days" when everyone was fighting with everyone else makes little sense. Building on the progress of the last several years makes a lot of sense. Painting an entire industry with a broad brush and essentially removing it from participation in CME is not acceptable, not productive, and runs the very real risk of once again causing dissension among the many contributors to continuing medical education. With unresolved disagreement comes new government regulations, an unpleasant prospect for all. Competition and cooperation with guideline compliance is good for CME.

Can for-profit CME providers meet the Essentials and Standards? Post your point of view on our Web site. Go to www.meetingsnet.com, click on Medical Meetings, then under Industry Issues, click on SMCDCME White Paper Comments and Discussion Forum. Or e-mail thosansky@mail.aip.com