Yesterday, the American Medical Student Association (AMSA) released their 2011-2012 PharmFree Scorecard, now in its fifth iteration. The Scorecard evaluates conflict-of-interest policies at the 152 medical schools in the U.S. and Puerto Rico, as well as a number of affiliated academic medical centers. With growing consumer and government scrutiny of the relationships between doctors and pharmaceutical companies (see, e.g., ProPublica’s series Dollars for Docs and the Physician Payment Sunshine Act), the Scorecard takes a unique look at how well professional standards are being introduced to the next generation of doctors. We don’t doubt the importance of education about pharmaceutical interventions and treatments, but it is also important to learn to question the veracity of information presented at industry-funded events, and understand the pharmaceutical marketing machine before a doctor begins her practice.
The Scorecard assesses policies that seek to reduce drug industry influence on the educational and clinical environment in which physicians do their training—including bans or limits on industry provision of gifts, meals speaker’s bureaus and samples; on industry influence on medical education and drug purchases by hospitals; on drug reps’ access to clinical areas; and, disclosure of industry relationships. This year’s grades demonstrate that medical schools are taking important measures to control the interaction between students or faculty and the pharmaceutical industry. Twenty-eight schools received an A (28 percent), 74 schools received a B (49 percent), 15 schools received a C (10 percent), and 13 schools received a D (9 percent). That leaves 9 schools with an F, and 15 “In Progress” schools. Despite progress overall, challenges remain, especially with policies on disclosure of financial ties with industry, samples, and access by sales representatives.
There are 102 schools with As or Bs (two-thirds!), up from 79 in 2010 and 45 in 2009. Four schools significantly improved their scores and went from F grades last year to B grades – gold star! These schools are University of Texas Health Center at Houston, University of South Carolina, Howard University, and Morehouse School of Medicine. Five other schools improved by two letter grades or more: Eastern Virginia Medical School, University of Arizona College of Medicine, Midwestern University – AZCOM Arizona College of Osteopathic Medicine and CCOM (Chicago), University at Buffalo, and OU-COM Ohio University – College of Osteopathic Medicine. And although other schools made this particular improvement, it is nice to see that Harvard Medical School has improved from a B to an A. (Recall that in 2008 they started with a great big F.) Kudos to the leadership (and student activists) who helped Harvard institute some of the strongest policies in the country, including a ban on speakers’ bureaus and a strong gift, disclosure and samples policy.
“It’s gratifying to see the improvement of medical school grades on the AMSA scorecard. This reflects the importance that medical schools are placing on the highest principles of professionalism. The policies that medical schools adopt set the tone for the culture of the institution that instills the values of professionalism in the medical students, residents, and fellows who train there.”
Stephen R. Smith, M.D., M.P.H. Professor Emeritus and Former Associate Dean for Medical Education Warren Alpert Medical School of Brown UniversityWe’ve come a long way since Brennan, Rothman and company published their seminal article in 2006 on conflicts of interest in academic medical centers and their impact on medical professionalism. To put those recommendations into practice, the Prescription Project was launched in 2007 at Community Catalyst, funded by Pew Charitable Trusts. In 2008, The Association of Academic Medical Centers (AAMC) stepped up with strong standards. For the last five years the AMSA Scorecard has served to keep everyone’s feet to the fire—while measuring steady progress and pointing to barriers that must still be overcome.
To look up any school and see all the details on what’s behind each grade, please visit http://www.amsascorecard.org/
Community Catalyst, AMSA, Pew Charitable Trusts and the National Physicians Alliance have now begun a new three year collaboration, The Partnership to Advance Conflict-Free Medical Education to address these issues at medical schools and AMCs. The initiative is made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.
— Anna Dunbar-Hester, Program Coordinator Prescription Access & Quality