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 (those graded A or B), according to the AMSA PharmFree Scorecard released today.
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 Web site that evaluates each school’s policies in 11 areas. The AMSA PharmFree Scorecard (amsascorecard) 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.
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. Top-ranked (‘A’) schools include: Mount Sinai School of Medicine (New York), the University of Pittsburgh Medical Center, the Uniformed Services University of the Health Sciences (Maryland), the University of California Los Angeles David Geffen School of Medicine, the University of Pennsylvania School of Medicine, the University of California Davis School of Medicine, and the University of California San Francisco School of Medicine.
Fourteen respondents received a ‘B’ (9 percent); 4 received a ‘C’ (3 percent); 19 received a ‘D’ (13 percent); and 60 received an ‘F’ (40 percent). Schools that declined to submit policies and schools that did not respond to repeated requests for policies received an automatic ‘F.’ Twenty-eight respondents received a grade of “In Process” because their policies are currently under review or revision.
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. These 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.
“It is time to extricate marketing practices from medical education,” says Dr. Brian Hurley, 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.”
“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,” continues Hurley.
In April, the Association of American Medical Colleges (AAMC) proposed sweeping recommendations calling for medical schools to adopt strong conflict-of-interest policies to address industry interactions. The AAMC recommendations affirm reforms that the Prescription Project and AMSA have actively promoted. The AMSA PharmFree Scorecard, along with an escalating push for policy reform by the AAMC, students, physicians, consumer groups, and federal and state policymakers is a clarion call for low-scoring schools to take action.
“The schools that earned ‘A’ and ‘B’ scores are to be commended for setting a high bar and aggressively moving forward to ensure medical education, training and patient care is free of commercial bias,” says Robert Restuccia, executive director of The Prescription Project. “While we still have a long way to go, we are optimistic that the growing momentum for reform will change the landscape and there will be great improvement next year.”
The Prescription Project offers toolkits to help medical schools create strong conflict of interest policies in many of the areas identified in the AMSA PharmFree Scorecard, including: the provision of gifts, meals and pharmaceutical samples, ghostwriting, support for continuing medical education, and drug and medical device procurement. Prescription Project toolkits are available at prescriptionproject.
Launched in 2002, AMSA’s PharmFree Campaign guides medical students in organizing to advocate for evidence-based rather than marketing-based prescribing practices, the removal of conflicts of interest and global access to essential medicines. AMSA provides toolkits, talks and training institutes to help medical students advance these goals. For more information, please visit pharmfree.
About the Prescription Project
The Prescription Project is led by Community Catalyst in partnership with the Institute on Medicine as a Profession. Created with The Pew Charitable Trusts, the Project promotes evidence-based prescribing and works to eliminate conflicts of interest in medicine caused by pharmaceutical marketing to physicians by working with academic medical centers, professional medical societies, public and private payers, and state and federal policymakers. For more information, please visit prescriptionproject.
About the American Medical Student Association
The American Medical Student Association (AMSA), with more than a half-century history of medical student activism, is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. With more than 67,000 members, including medical and premedical students, residents and practicing physicians, AMSA is committed to improving medical training as well as advancing the profession of medicine. AMSA focuses on four strategic priorities, including advocating for quality, affordable health care for all, global health equity, enriching medicine through diversity and professional integrity, development and student well being. To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at amsa/.
American Medical Student Association