Surveys on the relationships between medical academia and the
pharmaceutical industry have raised concerns over potential conflicts of
interest. To address the issues, more medical schools are establishing
policies and taking steps to limit the pharmaceutical industry's presence and
influence on campus, though with different approaches.
Academic experts have expressed growing concerns about the pervasive
presence of industry in undergraduate and post-graduate medical education.
Medical students and residents are exposed to this influence through meeting
pharmaceutical sales representatives; accepting small gifts such as pens,
mugs, and pads; and attending sponsored lunches and lectures.
More than 800 third-year students at eight U.S. medical schools reported
that they encountered on average one gift or activity provided by
pharmaceutical companies per week, according to a survey by psychiatric
educator Frederick Sierles, M.D., and colleagues that was published in the
September 7, 2005, Journal of the American Medical Association
(JAMA). Almost all (93 percent) had been asked or required by a
physician to attend at least one industry-sponsored lunch.
At a public meeting in Washington, D.C., in March organized by the
Institute of Medicine (IOM) Committee on Conflict of Interest in Medical
Research, Education, and Practice, a number of academic leaders offered
viewpoints and recommendations on industry presence in medical education.
Almost everyone acknowledged that its presence was "ubiquitous"
(see Experts Disagree on Impact of Medicine, Industry Relationship).
A number of medical schools have recently adopted policies intended to
eliminate industry influence in medical education. In January, for example,
Vanderbilt University issued rules forbidding its faculty and residents to
accept any gifts and meals provided by the pharmaceutical industry on campus.
Similar policies have been implemented at Yale University, University of
California at Davis, University of Pennsylvania, and Stanford University.
At the IOM meeting, Philip Pizzo, M.D., dean of Stanford University School
of Medicine, described the school's policy, which prohibits all
industry-funded free lunches at seminars and grand rounds, gifts to students
and faculty, and the presence of company representatives in the medical school
and affiliated hospitals without specified and approved purposes.
There was some initial faculty grumbling when these rules were approved in
October 2006. "There was a sense of dependence on the commercial sources
for providing education," Pizzo said. He told the IOM committee that
this policy has been well accepted for the past year and a half without any
It is not so easy, however, to extricate academic medical institutions from
extensive relationships with industry.
In a nationwide survey published in the October 17, 2007, JAMA, 60
percent of the responding department chairs in medical schools and the 15
largest teaching hospitals in the United States reported having some form of
personal relationship with industry, including serving as a consultant, a
member of a scientific advisory board, or a paid speaker. Half of the clinical
departments reported having received industry discretionary funds to purchase
food and beverages, 65 percent received support for continuing medical
education, and 37 percent got support for residency or fellowship training.
Overall 80 percent of clinical departments had at least one form of
relationship with industry.
"Data suggest that there is no aspect of medicine that is not in some
ways influenced by industry," Eric Campbell, Ph.D., the lead author of
the survey and an assistant professor at the Institute for Health Policy at
Massachusetts General Hospital and Harvard Medical School, told
Psychiatric News. "Every institution has deep connections [with
the industry]. University departments have relationships. People who serve on
IRBs [institutional review boards] and run department administration have
relationships. It is ubiquitous in academic medicine."
The survey showed that more than half of the clinical department chairs
felt that unrestricted industry grants are beneficial for the department's
ability to provide independent, unbiased education and training. "Like
everything else, this phenomenon has its benefits and risks. It is up to the
decision makers in medical education—the deans of medical schools,
residency program directors, department chairs—to decide whether the
industry presence in medical school is beneficial or not," said
The Association of American Medical Colleges (AAMC) has formed a Task Force
on Industry Support for Medical Education to "review the current
policies of medical schools and teaching hospitals for managing industry
support of educational activities and industry practices of presenting gifts
to students, residents, faculty, and staff," according to an AAMC press
release. This report and proposed guidelines are expected to be released in
"The most concerning influence from drug companies may be on medical
students," Linda Pessar, M.D., chair of APA's Committee on Medical
Student Education and a professor of psychiatry at the University of Buffalo
School of Medicine, told Psychiatric News. "[The
representatives] provide free lunches, hand out papers to students, and give
out branded items such as pens and mugs to students. There are different
opinions among educators on what should be the stance toward the relationships
between the industry and academic institutions."
She does not believe, however, that medical schools should eliminate all
presence of pharmaceutical companies on campus. "In undergraduate
education, teaching medical students about the boundaries between physicians
and pharmaceutical representatives is a bit like sex education," she
commented. "Blanket policies designed to protect students completely
from industry influence do not teach them how to deal with all the temptations
and bombardment of messages as soon as they step into practice in the real
world. That's like abstinence-only sex education; it won't be very
At the University of Buffalo, Pessar said, the faculty makes a concerted
effort to teach students how to manage industry-medicine relationships."
We do not ban drug company representatives from presenting papers, but
have faculty members present to guide discussions afterward. We try to make it
explicitly clear that the purpose of the flyers and gifts are sales and
In addition, second-year students are given lectures on how to evaluate
published articles critically, recognize commercial bias, compare
industry-funded studies and NIMH studies, and learn about research on the
psychological influence of taking gifts on physicians' attitudes and
"Our attitude is that medicine needs drug companies. To cast them as
the devil is unrealistic and unproductive.... We have to teach students how to
interact [with industry] through exposure and sophisticated education,"
This view was echoed by David Korn, M.D., senior vice president for
biomedical and health sciences research at the AAMC; he is leading its task
force on industry influence and medical education.
"How do we prepare trainees to interact with industry in a
principled, ethical way after they leave the 'germ-free' academic
environment?," he asked at the IOM meeting. He pointed out that there is
little research on effective strategies to help medical educators teach
students how to deal with the many shades of conflicts of interest with which
they may be faced.
An abstract of "Medical Students' Exposure to and Attitudes
About Drug Company Interactions" is posted at<jama.ama-assn.org/cgi/content/abstract/294/9/1034>.
An abstract of "Institutional Academic-Industry Relationships" is