Many medical schools and medical centers have adopted conflict-of-interest policies banning various industry inducements to influence students, trainees, and faculty clinical practice. The Pharmaceutical Research and Manufacturers of America, the trade association for drug companies, has also recommended that its member drug companies stop providing noneducational gifts and certain types of free meals to physicians.
It remains unclear, however, how widespread and effective these changes have been. The Institute on Medicine as a Profession, which maintains a comprehensive database of medical school conflict-of-interest policies,5 reported that the percentage of medical schools with strict policies increased from 10 percent in 2008 to 27 percent in 2011 but that there are still areas that need to be addressed, such as ghostwriting; free samples; continuing medical education, or CME; consulting; honoraria; and speakers’ bureaus.6
In 2008, the American Medical Student Association, or AMSA, with support from The Pew Charitable Trusts, created a medical school “scorecard” that annually assigns a letter grade to institutions based on how fully they comply with the Association of American Medical Colleges’ recommendations, which included restrictions or prohibitions on a number of practices, such as industry gifts and meals, speakers’ bureaus, and the presence of pharmaceutical sales reps on campus.7 According to the scorecard, the percentage of medical schools that have adopted policies consistent with the Association of American Medical Colleges’ recommendations, corresponding to an A grade, increased from 4.7 percent in 2009 to 25.3 percent in 2012.8
The policy provisions with the most dramatic improvements in grades have been those banning outright payments and gifts from industry. Conversely, relatively few schools have implemented policies restricting promotional speaking, eliminating industry support of accredited continuing medical education, and banning access to the institution by pharmaceutical sales representatives. In addition, even when schools have adopted well-crafted policies, compliance is not assured. One recent survey of medical schools, for example, found that up to half of medical students and residents reported receiving gifts from pharmaceutical companies, even in schools graded highly on the AMSA scorecard.9 Thus, while institutions can set guidelines and provide a level of oversight and enforcement, it is not clear that these are sufficient to change an individual’s behavior, much of which can occur outside of the institution’s purview.