Medical schools flunk pharma industry perks scorecard

Medical schools facing the same scrutiny as for-profit medical facilities. Source: Allied Medical School

Most U.S. medical schools are failing to address conflicts of interest caused by pharmaceutical industry marketing—only 21 of 150 medical schools surveyed by the American Medical Student Association (AMSA) have strong policies that address potential conflicts, according to the AMSA PharmFree Scorecard report released Tuesday.

AMSA collaborated with the Prescription Project, an industry watchdog group working to eliminate conflicts of interest in medicine, to develop a rigorous methodology and an interactive website that evaluates each school’s policies in 11 areas.

The AMSA PharmFree Scorecard evaluates restrictions on gifts, paid speaking for products, acceptance of drug promotion samples, interaction with sales representatives, and industry-funded education, among other criteria.

The top-ranked schools with strong policies addressing conflicts of interest, which are indicated by receiving an ‘A,’ include: Mount Sinai School of Medicine in New York City; the University of Pittsburgh Medical Center; the Uniformed Services University of the Health Sciences in Bethesda, Md.; the University of California Los Angeles David Geffen School of Medicine; the University of Pennsylvania School of Medicine in Philadelphia; the University of California Davis School of Medicine in Sacramento; and the University of California San Francisco School of Medicine.

Fourteen respondents (9 percent), including Stanford University School of Medicine in Stanford, Calif., and Columbia University College of Physicians and Surgeons in New York City, received a ‘B’; four respondents (3 percent), including Yale University School of Medicine in New Haven, Conn., received a ‘C’; 19 (13 percent) received a ‘D’; and 60 (40 percent) received an ‘F’.

Schools that declined to submit policies and schools that did not respond to repeated requests for policies received an automatic ‘F.’ Also, AMSA noted that 28 respondents received a grade of “In Process” because their policies are currently under review or revision.

AMSA reported that the pharmaceutical industry marketing to doctors has been estimated at $28 billion to $46 billion per year, with additional promotion by the medical device industry. This equates, conservatively, to $35,000 per year in marketing directed at each physician, on average.

More than 100,000 pharmaceutical sales representatives regularly visit U.S. physicians, providing free lunches, gifts, medication samples and carefully selected medical literature to promote their products, according to AMSA. The presentations and personal relationships are designed to influence doctors to prescribe more drugs and more expensive drugs and have often become a substitute for objective medical evidence, the association said.    

The AMSA PharmFree Scorecard offers a comprehensive look at conflict-of-interest policies across the country, as well as an in-depth, school-by-school look at policies that govern industry interaction with medical school faculty and trainees.

In April, the Association of American Medical Colleges (AAMC) Task Force proposed sweeping recommendations calling for medical schools to adopt strong conflict-of-interest policies to address industry interactions.

“It is time to extricate marketing practices from medical education,” said Brian Hurley, MD, AMSA’s national president. “There is substantial evidence that marketing shapes physician prescribing habits. By eliminating the gifts and the misleading information that pharma reps currently bring into our schools, hospitals and academic medical centers, physicians will be able to better practice evidence-based medicine. And that translates into better care for our patients.”

Hurley added that “AMSA’s Scorecard is meant to be not only a yardstick for measuring U.S. medical school conflict-of-interest policies, but also a guide for medical schools working toward adopting stronger and more practical policies.”

AMSA, the student association that represents more than 67,000 medical students, residents and practicing physicians, began its ranking in November when it requested conflict-of-interest polices from all of the U.S. medical colleges. The association made at least four attempts to receive the policies from every school in the country, but 16 schools declined to submit a policy and 29 did not respond at all.