"We won't have any speakers left." That was the opinion of numerous attendees at the 29th Alliance for Continuing Medical Education Annual Conference regarding the Accreditation Council for CME's draft revision of the Standards for Commercial Support. These guidelines regulate relationships between pharmaceutical companies and CME providers, and are designed to protect education from inappropriate pharmaceutical industry influence. The draft revision contains major changes, particularly in the area of speakers. The conference, which attracted about 1138 attendees and a record 61 exhibitors, was held at the Hyatt Regency Dallas at Reunion, January 29 to February 1.

The ACCME released the draft right before the meeting in order to spark discussion. The lesson for the ACCME: Be careful what you wish for. During sessions, breaks, and social events, attendees ranted about the proposed changes being too confusing and restrictive.

Currently, providers must ask speakers to disclose their relationships with pharmaceutical companies. The draft Standards assert that such disclosure is not enough to protect CME, and stipulates that speakers should be precluded from serving if their relationships with drug firms constitute a conflict of interest. But how does the ACCME define conflict of interest? Attendees peppered Murray Kopelow, MD, chief executive, ACCME, with their questions. What about a physician who owns stock in a company, or whose immediate family members own stock? What about the numerous physicians who serve as consultants or researchers for drug firms?

"The talk in the hallway is that if you interpret these guidelines to the most radical degree, anyone who has received a nickel of commercial support can't serve as faculty," one attendee told Kopelow. The problem, summarized another participant, is that the vast majority of medical experts would be disqualified from being teachers. "You take away our greatest tool. The greatest minds in medicine are virtually all involved in research or have other relationships with drug companies." Yet another CME provider added, "A lot of thought leaders are involved in industry. They will take affront."

Attendees walked away frustrated and infuriated when Kopelow did not answer questions to their satisfaction. Rather than offering specifics, he said that the new draft Standards, "are not meant to be insulting. We don't want to react to the doctors' reactions." Instead, he asked providers and physicians to discuss whether the concepts introduced in the draft would add value and credibility to the CME process.

Another potentially negative impact was revealed in a survey of the Pharmaceutical Alliance for CME special interest group. Respondents predicted that while the PhRMA code and the Office of the Inspector General's guidance for pharmaceutical manufacturers would lead to more money for CME, the revised Standards of Commercial Support might result in a reduction of CME funding.

For more coverage of the conference and the revised Standards for Commercial Support, watch for the March/April issue of Medical Meetings.