The continuing medical education (CME) system of the United States is being questioned for its integrity. Leaders in medicine and in government are asking about the effectiveness of CME, the influence of commercial support, and the value of CME credit and accreditation in assuring CME courses offer valid content, free of commercial bias. Nationally accredited CME organizations received $1.2B in commercial support during 2007, much of it associated with CME in formats shown to be less effective for improving clinical behavior and patient outcomes. There are few reliable data to respond to careful criticism. In 2007, U.S. expenditures for health exceed $2.2 trillion, with physicians responsible for clinical decisions that account for a large part of the spending. Approximately $4013 was spent per physician on CME. Rigorous studies are required to describe and explain relationships of CME accreditation and credit to better education and improved patient outcomes.