THE ISSUANCE OF the new Standards for Commercial Support in September 2004 and subsequent official, unofficial, and company-specific interpretations have produced yet another round of concern and finger-pointing among those involved in CME. Central to the debate is the definition, identification, and resolution of conflict of interest in relationships between faculty involved in the CME activity and commercial supporters of educational events. The potential for conflict of interest occurs when an individual faced with a situation requiring professional judgment is unduly influenced or compromised by a secondary interest, financial or otherwise. Being in such a position does not automatically translate to conflict of interest, or even to inappropriate choices or decisions, but those involved may have entered an area of ethical confusion and borderline choices.

Conflict of interest can result from direct and subtle influences such as monetary payments, gifts (in many forms), relationships with expectations of paybacks, and lucrative appointments to boards and committees. It can also occur when physicians are offered incentives for involvement in basic and clinical research; for serving on advisory boards affecting product approval, sales, and marketing; or for serving as faculty for continuing education and promotional programs. But unless doctors are found guilty of criminal behavior, it is next to impossible to know what influences an individual to a particular course of action. In CME, for example, it is very difficult to know whether a speaker is presenting the benefits of a medication in a truly unbiased manner or whether the speaker “owes” the supporting company. The best we can do is to trust the ethics and integrity of most physicians and other CME faculty, while at the same time setting standards for reasonable disclosure of potential conflict.

Encourage Candid Discussion

Except for the most egregious and obvious conflict situations, it is never appropriate to pass judgment on a speaker to the point of excluding him or her from the program. It is appropriate, however, for providers to gather and interpret as much information as possible about relationships between speakers and supporters, to question speakers about areas of concern, to alter speaking requirements, if necessary, and to share disclosed information with participants in the activity. Disclosure forms might also require speakers to reflect on their potential for conflict of interest based on the information they disclosed, and to reply to a question asking whether such relationships will in any way influence their content inappropriately.

Effort to bring conflict-of-interest issues and guidelines to the attention of faculty early in the planning and development process will, in most cases, prevent unpleasant and embarrassing circumstances and help to attain the desired result of unbiased and professionally acceptable CME. And it is much easier to face conflict situations at the outset rather than to try to resolve them later in the process.

CME providers and participants at every level should continue to educate both faculty and staff about the importance of adhering to the Standards of Commercial Support, particularly to sections that pertain to conflict of interest. By doing so, complying with conflict-of-interest requirements should become less time-consuming for both provider groups and CME contributors.

After all, shouldn't our best thinking — and our time — be focused on content and faculty development, event planning, and presentation of the subject matter in the best interests of medicine and patients?

Robert F. Orsetti is assistant vice president, continuing education, University of Medicine & Dentistry of New Jersey in Newark. Orsetti, a 24-year CME veteran, is a member of the AMA's National Task Force on CME Provider/Industry Collaboration. Contact him at (973) 972-8377 or send e-mail to For more of his columns, visit