"You can make money AND do the right thing," Robert F. Orsetti told us at a recent CME conference. An intriguing idea, especially considering the current debate as to whether for-profit medical education companies should be stripped of their accreditation. We caught up with Orsetti by phone to pursue that line of thought.

A 30-year CME veteran, Orsetti currently is based in Freehold, N.J., serving as vice president of the Medical Education Collaborative, a nonprofit accredited education company. He has also served as executive director, medical education and communications, at Ciba-Geigy for 22 years. An Alliance for CME fellow and board member for seven years, Orsetti also co-founded the Pharmaceutical Association for CME.

Q: Some in the industry have commented that there is a "wink-wink" attitude in the CME industry, where commercial supporters say to communications companies, 'You know how to make it look right.' Do you see a difference in the quality of education or adherence to Accreditation Council for CME Essentials and Standards between nonprofit and for-profit providers?

A: There's no doubt that some communication companies seem to do the bidding of their pharmaceutical clients, but most companies try to get it right. There are complicated issues. It is not correct to focus blame solely on communication companies. There are also examples of academic institutions placed on probation by the ACCME.

For-profits and nonprofits are equally prepared to deliver quality education and adhere to guidelines. What it comes to down to is a question of attitude and managerial direction within each organization. Companies who profess to accept the rules, whether CME provider or supporter, have an obligation to instruct everyone within their organizations regarding appropriate behavior--and I think that responsibility for education has to start at the top with the CEO and be passed down through the ranks. It is important for industrial decision-makers to appreciate that high quality CME validates promotional messages delivered to the physician community.

Q: You have said that it is possible to make money and do the right thing. Would you expand on that?

A: It's really pretty simple: Deliver a good product on time and in compliance with the existing standards. It's a matter of keeping the client company out of harm's way with the Food and Drug Administration, American Medical Association, and the other organizations that have the means to respond to violations. It's always best to advise a client of activities that are in violation or so close to the boundary that they are likely to be perceived of as such.

There may always be a climate of stretching the envelope, but if you have a good relationship with the client you can give examples of how to get to the same end point while being in compliance. Generally, the client accepts the wisdom of modifying the initial approach.

Very few companies will stick to their guns and continue to fly in the face of the guidelines, but if the client's decision is counter to standards and guidelines, then the education or communications company should walk away. To do otherwise undermines the CME system as a whole, and the company's reputation. The word travels fast in the CME community. In the short term, the compliant company maybe loses a dollar or two, but in the long term it gains respect and a solid reputation, which ultimately leads to new business.

Q: You have commented that there is a growing dissension in the CME world. What on your concerns?

A: It is not true dissension. Rather, we are seeing a predictable reaction to a growing number of guidelines violations. It is concern for preservation of the CME system. There is too much finger-pointing. People have to come together, as we did ten years ago, and solve the problems within the CME community. This is particularly important with the government again looking at drug pricing--that investigation, which is going on in Congress while we speak, could easily spill over into an investigation of appropriate funding of CME activities. If we're out there fighting among ourselves, we're going to be dismembered. If the CME community is unified in its approach and successfully self-policing, we won't be subject to close government scrutiny.