Conflict Of Interest Policies In U.S. Medical Schools Show Disparity

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Article Date: 14 Feb 2008 - 0:00 PDT

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Conflict Of Interest Policies In U.S. Medical Schools Show Disparity
According to a study in the February 13 issue of JAMA, a minority of U.S. Medical schools have adopted official policies regarding conflicts of financial interests for the institutions. In contrast, at least two-thirds have adopted policies regarding the financial interests of institutional officials.

Relationships exist between academic institutions and industry when academic institutions or their senior officials have a financial interest with or a finanicial interest in a public or private company. The authors state: "Institutional conflicts of interest (ICOI) occur when these financial interests affect or reasonably appear to affect institutional processes. These potential conflicts are a matter of concern because they severely compromise the integrity of the institution and the public's confidence in that integrity." Additionally, these conflicts may affect research results. As a results, the Association of American Universities (AAU) and the Association of American Medical Colleges (AAMC) have stated policies regarding ICOI which they endorse.

In this study, Susan H. Ehringhaus, J.D., of the Association of American Medical Colleges, Washington, D.C., and colleagues examined the magnitude to which U.S. medical schools have adopted ICOI policies. They surveyed deans of all 125 national accredited allopathic medical schools in the U.S. between February 2006 and December 2006, and received responses from 86 of them (69 percent response rate.)

The researchers' results were as follows:

• 30 of the survey respondents (38 percent) have adopted an ICOI policy spanning financial interests held by the institution.
• 29 of the respondents (37 percent) are working on adopting an ICOI policy related to financial interests held by the institution.
• 20 of the respondents (25 percent) are not working on this kind of a policy or do not know.
  

According to the authors: "Much higher numbers are reflected for ICOI policies that cover the individual financial interests of officials: with adoption of policies for senior officials (55 [71 percent]), midlevel officials (55 [69 percent]), institutional review board (IRB) members (62 [81 percent]), and governing board members (51 [66 percent]); and with adoption of policies being worked on for senior officials (9 [12 percent]), midlevel officials (12 [15 percent]), IRB members (6 [8 percent]), and governing board members (2 [3 percent]),"

Potential ICOI, for the majority of institutions, can be found in the financial interests held by an institutional research official for a research sponsor (43 respondents or 78 percent) or for a product that is the subject of research (43 respondents or 78 percent). Most institutions have adopted organizational structures that create a separation between research responsibility, investment management, and technology transfer. According to the researchers, a potential source of disparity lies in institutions informing their IRBs of potential ICOI in research projects that are under review.

"While acknowledging that adoption of ICOI policies is not a simple task and is dependent on, among other factors, highly interactive institutional databases and the active involvement of faculty, administrative officials, and the institution's governing board(s), it is problematic that more schools do not have more comprehensive policies in place," the authors conclude."The gaps in coverage suggest the need for continuing attention by the academic medical community to more consistently and comprehensively address the challenges presented by ICOI."

Responses of Medical Schools to Institutional Conflicts of Interest
Susan H. Ehringhaus, JD; Joel S. Weissman, PhD; Jacqueline L. Sears, MPH; Susan Dorr Goold, MD, MHSA, MA; Sandra Feibelmann, MPH; Eric G. Campbell, PhD
JAMA. 2008;299(6):665-671.
Click Here For Abstract

Editorial: Conflicts of Financial Interest in Academic Medical Centers

In an editorial paired with the preceding article, David J. Rothman, Ph.D., of Columbia University, New York, remarks on the results of Ehringhaus and her colleagues.

Dr. Rothman writes: "It is fair to ask whether it is naive to trust institutions to monitor and discipline their own financial activities, particularly when the financial returns can be substantial. Licensing agreements on patents generate close to $2 billion per year for academic research centers … At a time when federal research funding is declining and competition for philanthropic gifts is intensifying, universities may not be eager to promulgate policies that would restrict their freedom to maneuver."

"Will government regulation step in to fill the vacuum? Current federal and state interests in industry-academy relationships provide reason to believe so. Congressional hearings are addressing the implications of industry support for continuing medical education, gifts to clinicians, the sale of physician-prescribing data, and pharmaceutical company efforts to intimidate researchers critical of their product(s). Currently, 8 states and the District of Columbia have laws or resolutions affecting marketing of pharmaceuticals."

Academic Medical Centers and Financial Conflicts of Interest
David J. Rothman, PhD
JAMA. 2008;299(6):695-697.
Click Here For Extract

Written by Anna Sophia McKenney
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