Teaching Hospitals' Conflict-of-Interest Policies Fall Short, Students Say

A scorecard released by the American Medical Student Association finds that most of the hospitals reviewed had policies in place for internal disclosure of potential conflicts of interest, but no policies for disclosure to the public.

Fewer than one-in-five teaching hospitals makes the grade with their conflict-of-interest policies, according to a new scorecard from the American Medical Student Association.

The results were release this week as the federal government launched its Medicare Open Payments website, which contains data on payments by drug and device makers to physicians and teaching hospitals.

Of the 204 teaching hospitals examined, 35 received A's (17%), 111 received B's (54%), 31 received C's (15%), and 27 (13%) were graded "incomplete."

"As physicians-in-training, we have to be confident that the education we are receiving is free from conflict of interest," Britani Kessler, MD, AMSA's national president, said in prepared remarks. "That is why it is so important to AMSA to advocate on behalf of students to ensure that we retain the right to unbiased training."

The scorecard found that most of the hospitals studied had policies in place for internal disclosure of potential conflicts of interest, but no policies for disclosure to the public. Only 19 teaching hospitals met "model" criteria for disclosing potential conflicts of interest both internally and externally.

Heather Pierce, senior director, science policy and regulatory counsel, at the Association of American Medical Colleges, whose members include more than 140 teaching hospitals, declined to talk specifically about the report because she hadn't read it.

Pierce says that conflict-of-interest policies at teaching hospitals are different than those policies required of medical schools. "There may be less consistency in the written policies in terms of how things are phrased and addressed," she says.

"Generally though, at both medical schools and teaching hospitals, conflict of interest procedures and activities are pretty robust and have been developing to really address concerns that actual or perceived conflicts of interest could in some ways be harmful to patients or research subjects or to data and are created to safeguard against those conflicts of interest."

The rating is part of AMSA's Just Medicine Campaign, formerly called the AMSA PharmFree Scorecard. AMSA said the scorecard can provide medical students searching for a residency program with "an easily digestible view of each institution's attitude toward industry influence."

AMSA said its scorecard brings a measure of public accountability for pharmaceutical and medical device manufacturers' influence on purchasing decisions and even on the therapies available to patients at teaching hospitals.

Pierce says conflict of interest policy "has been on the radar for over a decade" at most medical schools and teaching hospitals.

"There are a lot of activities and processes that go into thinking about this," she says. "Part of a robust conflict-of-interest policy is the piece that allows institutions to know about, review, analyze and if necessary manage various financial interests of physicians, researchers or the institution itself to ensure that data, and patients, and clinical care and education are free of problematic relationships."

"It's important to note that there are many reasons why individuals and institutions do engage with industry in productive ways that advance discovery and biomedical research that can lead to better health and healthcare. Those are the kinds of relationships that our institutions not only allow but encourage."