The 2010 American Medical Student Association (AMSA) Scorecard is out today, and for the first time since the student group began assessing conflict-of-interest policies four years ago, one half of all U.S. medical schools received an A or B (78 out 152).

That’s up from approximately one in three schools last year, and just 20 percent in that range just two years ago, suggesting that we really are engaged in a nationwide project to figure out what the proper role of the industry in  medical education should be.

About one-fifth of medical schools improved their scores over last year, the same improvement rate as we saw in 2009 over the previous year’s Scorecard. We think that’s really good. Let’s remember that these are giant, slow-moving academic institutions – not exactly the hares of the system-change race. That makes such steady and significant shifts even more impressive.

As for “most improved” candidates for the we-wish-it-existed AMSA Scorecard Yearbook, Tufts University would have to be up there, moving from D to an A and to the top of the class this year among medical schools in Massachusetts, as would University of South Dakota Sanford School of Medicine and Des Moines College of Osteopathic Medicine, who also jumped from Ds to As in a year.

We should point out here that the room between A and B is somewhat complex. The scorecard is composed of 11 domains: -acceptance of gifts and meals from industry; -consulting relationships; -speaking relationships; -disclosure of financial conflicts; -pharmaceutical samples; -individuals with financial conflicts participating in university purchasing decisions; -financial support for educational events (on- and off-campus); -industry support for scholarships and trainee funds; -access of industry sales personnel to medical school or hospital personnel; -and inclusion of education about conflict of interest within the academic curriculum.

Each year, AMSA asks all medical schools, early and often, for their policies in each of these domains and then using methodology developed with the help of the Pew Prescription Project, independent blinded assessors evaluate the policy out of a possible three points.

The needle’s been harder to move in certain domains than in others.

Unsurprisingly, very few—10 percent of schools—got a perfect score on their on-campus continuing medical education policy. Drug company sponsorship of grand rounds and other on campus co-hosted educational activities is a big money maker for medical schools, and can give a company talk the imprimatur it craves. The Accreditation Council for Continuing Medical Education gets this, and its policy recommendations have lagged behind many rule-making bodies and medical groups on decoupling industry-physician marketing relationships.

More surprisingly, perhaps, even fewer schools – just two – got a perfect score on limiting access to sales reps. A score of “3” on industry access, according to AMSA’s scorecard site, is given to policies in which “pharmaceutical and device representatives are not allowed to meet with faculty regardless of location, or are not permitted to market their products anywhere inside the medical center and associated clinics and offices. (Exceptions may be made for non-marketing purposes, such as training on devices or equipment.)”

Schools that limit faculty and student interaction with sales reps, or where sales reps can go, but do not ban them, received a 2.

Still, the fact that no more than two schools banned sales reps outright is surprising to us because:

A) allowing sales reps on campus seems like the easiest, clearest example of letting industry inappropriately infiltrate your medical school. It’s in the name: they are there to sell stuff. Cutting out sales reps doesn’t get into questions of patient access to drugs or doctor access to education programs.

B)There are just less of them than two years ago. The last half of this decade hasn’t been a good one for sales reps, as pharma companies with trickling pipelines have slashed traditional marketing budgets in favor of … well, doctor-to-doctor CME, for one, and online campaigns. It seems that this would make it even easier for schools to put together great policies to keep the sales reps at bay. Maybe people need pens more than we thought.

For more, visit the 2010 scorecard at or check out the Pew Prescription Project resources on marketing and conflicts of interest.

–Kate Petersen, PostScript blogger