In the midst of increasing calls to ban pharmaceutical companies' gifts to physicians and medical students, a recent report from the American Medical Student Association (AMSA) says that most U.S. medical schools do not have adequate policies to address conflicts of interest involving industry marketing.

In a survey of 150 medical and osteopathic schools, 21 (14 percent) received grades of A or B for their conflict-of-interest policies, while 60 schools (40 percent) received a failing grade, according to a June 3 AMSA announcement. The survey, known as the AMSA PharmFree Scorecard, was conducted by the organization in collaboration with the Prescription Project, an industry watchdog group created by the Pew Charitable Trusts.

The scores were derived from assessments of each school's conflict-of-interest policies regarding acceptance of gifts and meals from industry, interaction with sales representatives, consulting and speaking relationships, disclosure of financial conflicts, financial support for educational events, and other issues.

Seventy percent of the schools contacted responded to the survey. The 16 schools that declined to submit their policies and 29 that did not respond to multiple requests were graded F. Another 28 schools (19 percent) told the surveyors that they were currently revising existing policies or creating new ones; these schools were given a grade of "incomplete."

The AMSA scorecard echoes a study published in JAMA last year that found extensive relationships between the industry and medical schools and teaching hospitals. The JAMA study also found that conflict-of-interest policies vary widely on permissible relationships between faculty and industry, and many policies were under revision (Psychiatric News, April 18).

The financial relationships between industry and medicine are under increasing scrutiny, with demands from within and outside of the profession to increase and tighten regulations. The Association of American Medical Colleges' task force on industry funding of medical education released a report in April that urged medical schools to "prohibit the acceptance of any gifts from industry by physicians and other faculty, staff, students, and trainees of academic medical centers, whether on site or off site."

The task force report also recommended that schools restrict access by pharmaceutical representatives to students and trainees and prohibit industry-funded travel, food, and meals (except food provided in connection with continuing medical education programs accredited by the Accreditation Council for Continuing Medical Education). When medical schools across the country will adopt these guidelines remains uncertain in light of the AMSA Scorecard findings.

"It is time to extricate marketing practices from medical education," Brian Hurley, president of AMSA, said in a press release. In 2002 AMSA began its PharmFree campaign, "a national movement to limit the access and influence of pharmaceutical companies at medical schools and academic medical centers," according to the organization's Web site.

If the medical profession, medical educational system, and industry do not police themselves, lawmakers may step in and do it for them. In April, the Massachusetts state Senate passed a bill to prohibit all gifts of any value to health care providers from pharmaceutical and medical device companies. The bill is waiting for approval by the state House of Representatives and the governor. A month later, New York Gov. David Patterson (D) proposed legislation to ban gifts and payments from drug companies to physicians and other prescribers with values exceeding $50 a year. Minnesota's legislature has already enacted a similar ban.

The AMSA assessment of conflict-of-interest policies is posted at<www.amsascorecard.org>." Report of the AAMC Task Force on Industry Funding of Medical Education to the AAMC Executive Council" is posted at<www.aamc.org/research/coi/start.htm>.▪