After receiving a "D" on last year's PharmFree Scorecard, a measure of conflict of interest policies at academic medical centers, the Hopkins Hospital has been preparing to implement tougher policies that would eliminate industry handouts.
The Scorecard, issued annually by the American Medical Student Association (AMSA) analyzes several factors of teaching hospital conflict of interest policy, including the extent to which institutions disclose gifts received from pharmaceutical companies and industry relationships.
According to a hospital press release, the administration takes the survey results seriously and intends to improve its performance in the future.
"The new policies - awaiting votes this spring by the Advisory Board of the Medical Faculty and other groups - are likely to eliminate all gifts and free food from industry,
strengthen existing limits on access to Hopkins by industry sales representatives and impose clearer standards regulating noncredit-awarding educational programs if they involve industry funding," the release said.
The new policies would require that funding be approved at the institutional, rather than the individual level. It would also eliminate the acceptance of free drug samples from industry representatives within a year, the release announced.
The new regulations would also require faculty members to disclose any consulting relationships that they might have with pharmaceutical or biomedical device companies.
A bill reintroduced in the Senate this January, known as the Physician Payments Sunshine Act, would mandate that any pharmaceutical companies or medical device manufacturers disclose payments to physicians greater than $100, excluding drug samples.
If passed, companies that knowingly fail to disclose such information would be subject to fines of up to one million dollars. The disclosure information would be available on a public website no later than September 2011.
According to data originally published in the New England Journal of Medicine in 2007, the pharmaceutical industry spends nearly $30 billion annually on marketing, the majority of which goes toward direct marketing to physicians.
Data from another article, published in the Journal of the American Medical Association in 2000, suggested that even small gifts such as free meals or travel subsidies produced a significant shift in prescribing behavior among physicians.
Nitin Roper, AMSA National PharmFree Chair, felt that strengthening regulations would help to limit the effect of pharmaceutical companies' influence on doctors' decision-making and to preserve objectivity in patient care.
"Physicians have a duty to provide patients the best treatments available based on the evidence, not on the multi-billion dollar marketing campaigns of industry," Roper wrote in an e-mail to the News-Letter.
Roper cited his own experiences in his first year of medical school as influential in motivating him to support the PharmFree cause.
"I began to clearly see the consequences of pharmaceutical marketing practices. I worked with physicians who routinely prescribed expensive, new medications because they had free samples," he wrote.
"I saw physicians giving lectures that were skewed because of their financial ties. I began to research the issue and uncovered how pervasive these marketing practices are in American medicine."
According to Roper, the PharmFree program has been influential in medical schools across the country.
"There is now, without question, a national trend at academic medical centers to establish ethics reform," he wrote.
"When I started working on this campaign two years ago, only a few schools had strong conflict of interest policies. However, since our scorecard came out last year (http://www.amsascorecard.org), dozens of schools have now implemented 'A' or 'B' policies."
Roper emphasized that while AMSA works to regulate restrictions on pharmaceutical marketing practices, the organization does not oppose the collaboration between scientists and industry in the field of research.
Anthony Chyou is a third-year student at the Hopkins School of Medicine and an advocate of the PharmFree movement sponsored by AMSA. According to Chyou, the issue of conflicts of interest in medicine is not easily solved.
"I do think this is a delicate issue, not as black and white as others will make it, because it is extremely hard to conduct cutting edge research without the extra help from the pharmaceuticals," he wrote in an e-mail.
"Moreover, innovations at pharmaceutical companies can help spark competition as we saw earlier in the Human Genome project. At the same time, we would not want the results of our basic science and clinical studies to be clouded by the profit-driven pharmaceutical companies."
As a member of the PharmFree movement, Chyou, along with other AMSA members, have sponsored events to raise awareness about conflict of interest and pharmaceutical marketing policies.
Hopkins is not the only school to have a low grade on the AMSA survey. Harvard, ranked as the number one research medical school by U.S. News and World Report received an "F" on last year's survey, while Yale, ranked ninth, received a "C."
The "F" ranking was assigned to schools who either did not supply data for the survey or did not have policies relevant to the survey.
According to the survey, Harvard Medical School reported that it had no conflict of interest policies that corresponded to the survey categories.
Of the 151 U.S. medical schools surveyed, only eight (five percent) received "A" rankings. The University of Pittsburgh Medical Center was one "A" recipient. The survey cited that their disclosure policies were exemplary, except for a curriculum content category, which they are currently addressing.
Both Harvard and Yale are working to improve their conflict of interest policies and performance on the AMSA survey.
Last Thursday, a 19-member committee met at Harvard Medical School to draft new conflict of interest policies, following criticism of the school's policies in the past.
The PharmFree cause has recently been a popular topic among medical students. At Yale, a group of three first-year medical students are organizing a campaign to request full disclosure of affiliations between professors and pharmaceutical companies.
Similarly, at Harvard, medical students have been pressuring for greater transparency and strengthened conflict of interest policies to preserve the objectivity of their medical education.
Some Harvard students felt that having professors who received money for consulting from drug companies could impact the way that they taught material, while others felt that the relationship between drug companies and physicians was not so harmful, the New York Times reported.
About 1,600 of 8,900 professors and lecturers from Harvard have disclosed financial ties under the school's disclosure policy, according to the Times.
