At a CME providers' conference several years ago, I served on a panel where one of the speakers launched into a commercial about her company's product. When participants asked her questions, she responded with more anecdotes about her company. Such a blatantly promotional presentation was infuriating for attendees and embarrassing for me as her co-panelist. However, I don't think anyone believed that her talk was balanced or even informative. Just as attendees at your CME activities — healthcare professionals trained in analytic thinking — aren't fooled when one of your speakers, despite your best efforts to ensure an unbiased presentation, turns his speech into a drug advertisement.

What concerns me even more are the hidden influences on speakers. Both Murray Kopelow, MD, Accreditation Council for CME, and Rich Tischler, PhD, Viator Medical Communications, have raised the issue of faculty who have signed nondisclosure or confidentiality agreements with pharmaceutical companies. Since these relationships are secret, speakers will not reveal them on your disclosure forms. You may know that the speaker has a financial relationship with XYZ Pharma, but you won't know that there is certain information that he or she cannot include in the presentation.

It seems to me that the current disclosure rules need to be expanded to address relationships such as these. In order to develop guidelines that will be practical and effective, representatives from industry as well as CME providers need to come to the table and figure out how to address this sensitive area. As Tischler suggests, the subject matter of the nondisclosure agreement doesn't have to be revealed, but the speaker could divulge that there is such an agreement. Armed with that knowledge, you might then decide to bring in additional faculty who don't have those relationships, and/or discuss your concerns with the speaker.

Of course, questioning the authority of a high-powered speaker can be quite intimidating, especially for non-MDs. I admire the courage of the CME providers interviewed in “Is Pharma Pulling the Strings?” (see page 38), who stand up to faculty when they cross ethical lines. I hear from you frequently about how difficult it is to stick to your beliefs, and I encourage all of you to listen to your own instincts, even when it means asking disturbing questions about inflammatory issues such as confidentiality agreements. As Linda Wilhelm, Floyd Medical Center, states in the cover story, “It's our program. We're committed to doing it right.”