Oh, those crazy kids. For the past four years, the American Medical Student Association has been tracking conflict-of-interest policies and, very publicly, ranking the progress - or lack thereof - at med schools around the country. Generally, the results played up the failings (see here). For the first time, however, the AMSA finds that most schools have implemented what it calls 'strong' policies.
To wit, the official PharmFree Scorecard found that 52 percent, or 79 of 152 med schools, now receive a grade of A or B for policies governing interactions between faculty and students and the pharmaceutical industry. That's up from 45 schools, or 30 percent, last year. More specifically, 19 received an A and another 60 were given a B. Two dozen got a C and 18 notched a D. That means 26 failed, including 12 schools that refused to submit policies or declined to respond to repeated requests for info. Another five were marked 'In Process,' since policies are currently under review or being revised, which is rather sporting.
Interestingly, the AMSA says there were two med schools that received a perfect score for limiting the access sales reps to students and faculty – the University of South Dakota Sanford School of Medicine and Florida State University College of Medicine. And nearly one-third now teach students to understand institutional conflict of interest policies, to recognize how industry promotion and marketing can influence clinical judgment and to consider the ethics around conflict of interest (see the scorecard here).
Over the past few months, several med schools have adopted policies and generated discussion in the process (see here and here). The Scorecard, by the way, was developed with help from the Pew Prescription Project. "The bottom line is we see continued momentum for the Scorecard, reflected in a record number of new policies submitted this year," Pew director Allan Coukell writes us. "More and more schools have strong policies, although close to half of all schools still need to do better."
11 Comments
I know several medical students personally whom I mentor, and I can guarantee you that they with the $300,000 they are paying for four years of med school they would not feel in the slightest conflicted if they received the same free Lilly medical bag, Littman stethoscope and Welch-Allyn ophthalmoscope/otoscope that I received as a second year student, worth many hundreds of dollars. We never even saw the reps that left these things. They were handed out by our professors. If you know a 2010 med student then you know someone with an iron will, who would run through a brick wall to get a medical education, and, one not likely to be influenced by a rep handing out a medical bag and a donut.
How tiresome to see the endless apologetics.
Anyone who has seen the industry from this end knows its endless schemes, across multiple fronts and tactics, to manipulate medical education for marketing ends.
Honesty appreciated.
University insider, I don't know what medical school you are in. but here's the scoop from a second year medical student's perspective, which is the year I received my instruments from the pharmaceutical companies. The second year student is responsible for learning vast quantities of information pertaining to Pathology, Microbiology, Pharmacology, Physical Diagnosis, Behavior, Immunology, Behavioral Science, Clinical Laboratory Medicine, Clinical Epidemiology and various required electives. All in 36 weeks, and the experience is like trying to drink from a gushing fire hydrant without drowning. Again, I maintain that with all that course work the last thing the med student will retain is the identity of the companies from which he received his complimentary instruments. If he/she does retain that information, it will definitely leave his/her brain before the next weekly exam. In my case, it wasn't until third year of med school that I even looked at the names on the instruments, and those names left my mind as quickly as they entered.
To believe otherwise tells me that you have neither been a medical student or understand how such student thinks, and how that, IMHO med schools have really overreacted when it comes to how much they think students can be influenced.
Oh, and BTW, I say that from the perspective of having wotked in pharma for the past 28 years.
Times have changed, my friend. If you want to know "how medical students think," then you have to ask yourself why the PharmFree movement has gained such support across so many schools. You have to ask yourself why the surveys of med. students come out as they do.
Are all these medical students brainwashed as well as overworked?
If they are as smart as you suggest they are, then perhaps their views on these matters should be taken seriously.
35 years for me.
btw, read the AMSA statements again. Most of them are not about bags and stethoscopes.
I want to know who is paying for the fellowships. I want to know who is paying the consulting and speaking fees for the attendings who train the fellows. If none of that matters, why is it so hard to find out that information? Not all the drug companies have released their doctor payment lists. I think the med schools should have it on their websites.
If today's med students have time for PharmFree and other sorts of things like that, my hat is off to them. I had all I could do to keep up with my studies and still get 4-5 hours of sleep/night. It even resulted in my first wife divorcing me after making the mistake of marrying me after my first year of med school.
It's a good start, but doesn't address the fact that those who are making treatment decisions are receiving incremental payments for each treatment they decide to administer.
Chasing the pharmaceutical industry bogeyman does do a great job of distracting attention from the larger COI problem, however.
There is a problem when you ask an attending about an FDA warning letter and the fellow uses the exam room computer to consult Google to try prove you are wrong. Why do I know this stuff before they do?
Suzanne, please keep in mind that I love warning letters dearly. And the Dr should not have argued with you, in my opinion.
That said, may I suggest that since FDA Warning letters are defined as "informal communications" and "Matters described in FDA warning letters may have been subject to subsequent interaction between FDA and the recipient of the letter that may have changed the regulatory status of the issues discussed in the letter." Frankly they need to know some things that are at a higher level of urgency - please be more concerned if you have to say call the office of a relatives very excellent cariologist to mention a recall that was "news to them."
Specifically - something like the ABLE Labs debacle which included the nitroglycerine tablets that were there "just in case" - and still in the local pharmcy when I went to get a replacement! Physicans office and pharmacy both took action swiftly to deal with their supplies but I had to tell them first.
I think it is reasonable to expect them to be aware of even informal communications since it is pretty much the only drug they ever push, er, recommend. I will accept that my thinking is that regard is unreasonable; however, I will never accept the actions of the fellow. I wanted to tell him he needed to alert the FDA to the results of his Google search. The attending later told me that should not have happened; I'm still uncomfortable that he told me there had no cases in peds when in fact there had been (after all, I can Google, too.) Anyway, my concern is no longer in question, as the label has been changed to include what I asked about.