California medical schools earn A’s in conflict grading

Bernadette Tansey

Drug companies shower medical school faculty members with pens, pricey dinners, free samples and other inducements to influence their prescribing patterns, an organization of U.S. medical students says.

The med students are now trying to erase that pattern by grading their teachers. The American Medical Student Association issued its second annual report card Tuesday on the conflict-of- interest policies maintained at 150 universities that grant a medical degree.

California dominated the honor roll. UC Davis, UCSF and UCLA captured three of the seven A grades across the country. But only 15 percent of U.S. medical schools made the top of the class with a grade of A or B, based on their adoption of rules such as barring drug companies from distributing lavish gifts to physicians.

Sixty of the schools, or 40 percent, got an F on the student association’s 2008 PharmFree Scorecard.’

But changes are coming fast, the med students’ group said. Many of the top-scoring schools have recently beefed up their policies.

“We’re at a tipping point,” said Rebecca Sadun, director of student programming for the medical students’ association. “Schools are beginning to realize the critical role they play in eliminating conflicts of interest and training future physicians to make evidence-based decisions.”

Dr. Neal Cohen, vice dean of the UCSF medical school, said he helped draft conflict-of-interest rules that have been in effect for about a year.

The aim was to assure both students and patients that the medical care provided is free of influence or bias. Student groups had a significant impact on the policies, Cohen said.

“Certainly the students here at UCSF had influence and put pressure on us to address some issues and move a little faster,” Cohen said.

The American Medical Student Association started its PharmFree campaign in 2002 after members shared their concerns about interactions they observed between their medical professors and drug industry representatives, Sadun said.

One student saw his mentor accept a $100 dinner from a pharmaceutical company representative and promise to switch some of his patients to the company’s drug, she said.

Smaller gifts such as pens and clocks that bear a drug logo can be the most pernicious freebies, Sadun said. Doctors are more likely to prescribe the product pictured on those items, she said. “You’re seeing that name all day.”

The Association of American Medical Colleges in April proposed that all med schools adopt policies to prevent drug marketing efforts from distorting the educational environment. The proposed rules would restrict industry funding of seminars, forbid companies from selecting the recipients of scholarships they fund and strongly discourage medical school faculty members from participating in industry-sponsored speakers’ bureaus.

“Over recent decades, medical schools and teaching hospitals have become increasingly dependent on industry support of their core educational missions,” the association said in its April report. “This reliance raises concerns because such support, including gifts, can influence the objectivity and integrity of academic teaching, learning and practice.”

While medical schools are coming under increased scrutiny, doctors in private practice have no similar watchdog group or professional association dogging them with equal fervor to reject drug company handouts, said Allan Coukell, director of policy at the Prescription Project, a Boston nonprofit group that helped the med student association design its scorecard.

“If the medical schools address this, the rest of the profession will follow,” Coukell said.

The association’s 2007 report graded schools solely on whether they had adopted a conflict-of-interest policy. The PharmFree Scorecard of 2008 examines the specific policies adopted by the schools.

Stanford University and UC Irvine both rated B’s, while the Keck School of Medicine at the University of Southern California was given an incomplete because new policies are being considered.

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