Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 83

limit bias in big pharmaceutical companies’ CME activities and
indicated that the ACCME focused on the
documentation surrounding the process for funding and creating CME activities, as opposed to the substance of the activities themselves. For example, it does not appear that ACCME
review involves analyzing the contents the educational activities
created for accuracy, to determine whether the activities include
a fair and balanced discussion of competing therapeutic options, or whether the activities favor products manufactured
by the commercial sponsor (6).

By extension, one can see the implications: the integrity of
clinical trials, biased and tainted dissemination of knowledge,
and the degradation of the very fabric of trust between physician, patient, and society. From this perspective, the notion that
the abyss-like pockets of the pharmaceutical industry are funding CME at fine restaurants, ski resorts, and cruises is unsavory
to contemplate. More troubling is the conflict of interest that
is inevitable in presentations of industry-sponsored research of
principal investigators whose research is often also funded by the
National Institutes of Health (NIH). Such potential conflicts of
interest fueled the skepticism of the Senate Finance Committee
about the role and independence of the CME enterprise.
In the spirit of engaging this congressional criticism, the
ACCME developed the descriptions and guidelines that appear
in the box below (7). Unfortunately, CME offices across the
country, faced with increasing scrutiny and threats of probation
Continuing medical education consists of educational activities which serve
to maintain, develop, or increase the knowledge, skills, and professional
performance and relationships that a physician uses to provide services for
patients, the public, or the profession. The content of CME is that body of
knowledge and skills generally recognized and accepted by the profession
as within the basic medical sciences, the discipline of clinical medicine, and
the provision of health care to the public.
ACCME Note:
The definition below describes the content that the ACCME considers
acceptable for activities developed within an accredited provider’s
CME program. The ACCME definition of CME is broad, to encompass
continuing educational activities that assist physicians in carrying out their
professional responsibilities more effectively and efficiently. Examples of
topics that are included in the ACCME definition of CME content include:
• Management, for physicians responsible for managing a health care
facility
• Educational methodology, for physicians teaching in a medical school
• Practice management, for physicians interested in providing better
service to patients
• Coding and reimbursement in a medical practice
When physicians participate in continuing education activities that are
not directly related to their professional work, these do not fall within
the ACCME definition of CME content. Although they may be worthwhile
for physicians, continuing education activities related to a physician's
nonprofessional educational needs or interests, such as personal financial
planning or appreciation of literature or music, are not considered CME
content by the ACCME.
Figure. CME content: definition and examples. Source: ACCME (7).
April 2014

for inappropriately awarded CME credit, began refusing to offer
CME for history of medicine seminars. This contrary action by
institutional CME boards continues despite the language outlined by the ACCME, which provides support for the history
of medicine as an avenue for legitimate intellectual inquiry and
study serving to benefit the practice of medicine.
THE CHALLENGE OF CME FOR MEDICAL HISTORIANS
What are physician historians of medicine to do? Caught
in the cross-hairs of a skirmish involving the pharmaceutical
industry, well-intended congressional members, and the formal
CME enterprise, physician historians of medicine have become
victims of unintended collateral damage. What is at stake?
Dollar-wise, not much. Money spent on academic history of
medicine conferences is a mere pittance compared to the cascade
of dollars involved in NIH grants and pharmaceutical funding
for drug research and development and drug trials. Most history
of medicine conferences receive no pharmaceutical industry
funding. Depending on the particular conference, a variable mix
of PhD graduate students, history professors, lawyers, librarians,
physicians, and a slowly increasing breed, an MD with a PhD in
history, attend these gatherings. A drug company representative
is hard to find under these circumstances, although rare book
dealers often set up shop on the environs.
What is at stake is the long and fruitful intercourse between
physicians and historians of medicine, and the resulting benefit
to patients and society. Note the opening paragraph of a recent
article in the New England Journal of Medicine:
Over the past half-century, historians have used episodes of
epidemic disease to investigate scientific, social, and cultural
change. Underlying this approach is the recognition that disease, and especially responses to epidemics, offers fundamental
insights into scientific and medical practices, as well as social
and cultural values. As historian Charles Rosenberg wrote,
“disease necessarily reflects and lays bare every aspect of the
culture in which it occurs” (8).

In the swirling winds of discontent and the increasingly politicized milieu in which medicine is practiced today, the profession
of medicine would do well to understand its roots and its role in
society and to account for how we have arrived at the current state
of affairs. As Harvard historian Peter Bol sagely observed:
How do I know the historian’s mind-set when I see it? I know
it because it’s somebody interested in how things change over
time, but not just that. They’re also interested in the problem of
how things change over time. And how to account for change
over time (9).

CME AT THE AAHM 2013 ANNUAL MEETING: TOWARD A
NEW PARADIGM
Confronted with this disconnect between CME and history of medicine scholarship, a group of scholars, including
these authors, hosting the 86th annual meeting of the American
Association for the History of Medicine (AAHM) in May 2013
offered a novel 6