“I've had an awful experience,” a CME provider with a small organization called to tell me. When a pharmaceutical company — supposedly giving an unrestricted grant — didn't approve of her choice of speaker, they told her she was being unpleasant, uncooperative, inflexible, and unwilling to compromise. “Compromise,” the provider explained to me, “means doing it their way.”

When she held her ground, they told her if she didn't go along with them, other providers would. And then they said their company would never fund her organization again.

This is not the first time I've heard that story. In fact, at the hearing convened in July by the Accreditation Council for CME to reexamine the Standards for Commercial Support, Morton Morris, D.O., American Osteopathic Association, commented, “It may be an unrestricted grant, but we all know it's coming for a particular speaker. Whether you pick that person or not — you probably did — but in fact, you have to, or the money is not forthcoming.” (See “No More Compromises”, page 123.)

And if you say no to pharma and walk away from the grant, technically there has been no violation of the Standards, since you didn't do the CME activity — there's nothing to report. Even if you do go along with it, as Morris pointed out, on the surface it looks like you did exercise control. Are you really going to tell the ACCME that yes, you chose the speaker, but only under duress?

The woman who called me said she appreciated MM because it comes “close to telling the truth.” That's not good enough for me. I want to get closer to the truth, but I need your help. I know many of you are afraid. Afraid of losing more grants. Concerned about the negative media stories, about bringing down blame on the whole CME community from the wider medical field, the public, the government. I respect your concerns. Before writing this editorial, I asked the provider who called me if I could use her story anonymously. I'll do the same for you.

Silence only gives the illusion of safety. We can figure out effective solutions and strategies only if we first break the secrecy and expose unethical behavior. I'm waiting to hear from you.