Time for Med Schools to Adopt Conflict of Interest Policies

It shouldn't take an IOM recommendation to ban ghostwriting, and yet one-third of medical schools still allow it. Why aren't all medical colleges in compliance with the fairly straightforward clinical conflict of interest policies set forth by four prominent medical associations?

What's taking so long?

It's been seven years since the first of a series of detailed guidelines from four blue chip associations addressed clinical conflict of interest at the nation's medical schools. In 2006 the Institute for Medicine as a Profession and the American Board of Internal Medicine Foundation issued guidelines, followed in 2008 by the American Association of Medical Colleges and in 2009 by the Institute of Medicine.

See Also: Med Schools Failing on Conflict of Interest Policies

And yet a report in the October issue of Academic Medicine that examines clinical conflict of interest policies (CCOI) at the nation's medical colleges finds that while progress is being made, these hallowed training grounds for the physicians of tomorrow remain lax at teaching them about inappropriate behavior.

For example, the Institute for Medicine as a Profession review found that nearly one-third of medical colleges still have no prohibitions on ghostwriting. Nearly two-thirds of medical colleges still lack policies to limit ties to industry, including gifts, meals, drug samples, industry-funded continuing medical education, and payments for travel, consulting, and speaking.

Only 16% meet national standards in at least half of the areas, and no school met all the standards.

None.

"We actually have these standards," Susan Chimonas, lead author of the study, associate director of research at the Center on Medicine as a Profession at Columbia University, told me in a recent interview. "We've had three independent bodies of experts coming to basically the same conclusion about what these policies should look like or involve. Several years have gone by now and many schools are not coming even close to meeting those policies."

Some progress
In fairness, let's acknowledge that progress is being made and that many needles are pointed in the right direction. The survey examines CCOI policy changes from 2008–2011. As reported this week, in 2008, "no policy" was the most prevalent finding in all but one CCOI area. By 2011, the number of schools with no CCOI policies dropped from more than one quarter in 2008 to less than 2% in 2011.

Of the 12 areas examined for CCOI the survey found that the number of medical colleges in the "moderate" range more than doubled, from 14% to 30%, while the number of schools with strong policies in eight or more areas barely increased, from 1% in 2008 to 4% in 2011. Eighty-four percent of schools had substandard policies in seven or more areas.

Based on the progress demonstrated from 2008–2011 CCOI policies have gotten more stringent in the past two years that were beyond the IMAP review.

What's the delay?
While we can acknowledge successes, it is also fair to ask what's taking so long. Why aren't all medical colleges in compliance with these fairly straightforward CCOI policies? This is not a cure for cancer. It's a policy change that could be implemented with a pen stroke.

Yes, some relationships between physicians and medical device companies, pharmaceutical companies, and other businesses are legitimate and valuable and serve a public good. For the most part those sorts of relationships can be identified, defended and exempted from CCOI action.

Other CCOI practices are obviously wrong and should have been banned years ago. It shouldn't take an IOM recommendation to ban ghostwriting, and yet one-third of medical schools still allow it. Ghostwriting is either plagiarism, bribery, or both.

Accepting money or other compensation to shill for medical research that someone else did is worse than plagiarism because physicians are cashing in on their profession's hard-earned credibility and public trust to hawk a product. The actions of a few physicians who violate this public trust harm the reputations of the vast majority of physicians who do not.

Heather Pierce, senior director, science policy for the Association of American Medical Colleges, said in an email exchange with me that national transparency initiatives such as the Physician Payment Sunshine Act are spurring dialogue in medical colleges about the value of more-stringent CCOI policies.

This is encouraging. It is also unfortunate that medical schools may be motivated by fear of disclosure and public embarrassment to adopt common-sense CCOI standards and not because it's the right thing to do.

In any event, they should hurry up and do it.