The trend by U.S. medical schools to establish or strengthen policies to
regulate and restrict conflict-of-interest problems in relationships with the
pharmaceutical industry has picked up steam since 2008, a survey by the
American Medical Student Association (AMSA) has found. However, 1 in 4 schools
still received a failing grade.
The AMSA PharmFree Scorecard is based on an annual review of
conflict-of-interest policies at about 150 medical and osteopathic colleges
throughout the country. In collaboration with the Pew Prescription Project,
the AMSA developed a rating system to evaluate how stringent and encompassing
each school's conflict-of-interest policies are. Two AMSA reviewers who were
blinded to the medical school under review independently evaluated each policy
on areas such as acceptance of industry gifts and meals; consulting and
speaking relationships with industry; purchasing and formulary decisions made
by health care professionals with potential conflicts; disclosure requirements
for potential financial conflicts; acceptance of industry support for
education, scholarships, and trainee funds; sales representatives' access to
the medical school or affiliated hospitals; and potential conflicts in
teaching and curriculum.
In each area assessed, a policy is given a grade ranging from 0 to 3, with
3 being "model policy," 2 being "good progress toward model
policy," and 1 being "policy is absent or unlikely to have a
substantial effect on behavior." Institutions that did not respond to or
declined to participate in the survey received scores of 0 in every category.
The scores were totaled, and institutions with less than 40 percent of the
maximum received an F.
Compared with the survey scores from last year (Psychiatric News,
July 4, 2008)—the survey's first year—this year's scores indicated
that the schools generally have made progress on improving
conflict-of-interest policies. The proportion of schools receiving a grade of
F decreased from 40 percent to 23 percent. Thirty percent of the schools
received a grade of A or B this year, up from just 14 percent in the previous
survey. Overall, 21 percent of the schools improved on their previous
Thirty-four schools (23 percent) were designated as "In
Process" since they were revising current policies or drafting new
policies at the time of the survey.
With an 88 percent response rate, this year's survey had higher
participation than did last year's when 70 percent of the schools provided
their policies for review. This year just 10 schools did not respond to the
survey, and 13 declined to submit their policies.
A week after the scorecard was released, Sen. Charles Grassley (R-Iowa)
sent a letter to the 23 medical and osteopathic schools that did not respond
to or declined to participate in the survey. His June 24 letter asked for each
school's conflict-of-interest policies and disclosures of faculty members'
financial conflicts if they have grants from the federally funded National
Institutes of Health. Grassley has been a vociferous advocate for more
regulation of the pharmaceutical industry. He has introduced the Physician
Payments Sunshine Act, which will, if passed, require all manufacturers to
publicly disclose gifts and payments to physicians.
"Senator Grassley's request was an unintentional byproduct of the
AMSA PharmFree Scorecard, but it demonstrates how many different parties are
interested in conflict-of-interest issues in medicine," Branden
Pfefferkorn, M.D., AMSA's 2009 PharmFree Scorecard director, told
Psychiatric News. "The influence of marketing has been
inadequately controlled for too many years, and if medical students and
physicians aren't willing to step up and fix the situation, it is becoming
clear that state and federal legislators will step in to fix the
A number of events during the past year continued to fuel the
conflict-of-interest debate in academic medicine. In 2008, the Association of
American Medical Colleges, for example, issued policy guidelines urging
medical schools and research institutions to develop and implement
conflict-of-interest policies by 2010. In addition, pharmaceutical companies
have widely adopted the new Pharmaceutical Research and Manufacturers of
America (PhRMA) code of conduct for marketing practice, which prohibits sales
personnel from giving gifts to or entertaining health care professionals and
restricts certain promotional activities (Psychiatric News, October
Also in recent months on the conflict-of-interest front, several large
pharmaceutical companies, under legislative pressure from state and federal
governments, began to post online disclosures of payments to physicians.
Further, several major medical schools and academic institutions, including
Harvard Medical School, Johns Hopkins University Medical School, and the Mayo
Clinic, have strengthened their conflict-of-interest and disclosure policies.
Earlier this year, a widely publicized Institute of Medicine report called for
a ban on all gifts from industry to medical school faculty and all physicians
(Psychiatric News, June 5).
The scorecard is part of the AMSA's PharmFree campaign, one goal of which
is to promote evidence-based prescribing among physicians in training.
"The AMSA PharmFree Scorecard illustrates the influence and power
medical students can have to stand up and disagree with current practices that
we feel are not acceptable," said Pfefferkorn. "With the
scorecard, we encourage medical school administrators to at least meet the
standards of their peer institutions.... By pairing with the Pew Prescription
Project, we not only evaluate school policies but also provide both medical
students and school administrators with the resources to successfully effect
Details of the AMSA PharmFree Scorecard, including schools'
assessments, are posted at<www.amsascorecard.org>.▪