Conflict-of-interest scorecard expands to teaching hospitals

Because conflict-of-interest issues are not confined to medical schools, the American Medical Student Assn. is expanding its influential grading system for such policies to more than 400 teaching hospitals.

For the next scorecard, to be released in April 2014, AMSA, together with the Pew Charitable Trusts, will raise the scoring bar and improve the methodology to better capture the nuances of each institution’s policies. The previous 11 domains for evaluation will be broken into 14 for medical schools and 16 for teaching hospitals — with scoring to range from 1-5 instead of 0-3.

One difference will be in scoring schools on whether faculty are involved in industry-funded speaking relationships. Some schools demand institutional approval for faculty to have a speaking arrangement with industry, and the old scoring system didn’t take this pre-approval into account. The new scorecard will give more credit for the approval step.

Among other changes is the category for consulting. The new scorecard will differentiate between consulting done for scientific purposes and consulting for promotional purposes.

Reshma Ramachandran, a fourth-year student at Warren Alpert School of Medicine at Brown University in Rhode Island and a fellow in pharmaceutical policy at AMSA, said that although the criteria will be tougher, she doesn’t expect overall grades to drop. “Schools with very strong policies tend to keep their good grades,” she said, adding that more categories and levels of scoring probably will result in bigger differences among the institutions.

Grades up over six years

AMSA has been grading hospitals’ conflict-of-interest policies since 2008 (link). The PharmFree Scorecard was developed in response to students’ concerns about the pharmaceutical industry’s influence on medical education.

In a recent webinar explaining the scorecard changes to hospital and medical school representatives, Daniel Carlat, MD, a psychiatrist and director of Pew’s Prescription Project, which works to ensure transparency in physician-industry relationships, said the need for the scorecard escalates with the increasing amount of money spent to promote drugs and equipment.

“There’s been growing medical literature that has associated pharmaceutical promotional practices with changes in doctors’ attitudes and also, more recently, with doctors’ prescribing behavior,” he said.

Dr. Carlat noted that AMSA’s medical school scores have increased steadily. The percentage of schools scoring A or B grades has increased from 30% in 2008 to 72% in the latest report.

One area where many medical school faculty fall short is in disclosing ties to industry before they speak to students, Ramachandran said.

“There’s a very easily implemented policy,” she said. “They just need a second slide after the title slide. … We’ve worked with schools and students one-on-one to create a second-slide campaign.” Students are encouraged to go to the administrators and provide templates faculty can use for disclosures.

The American Medical Association’s policy on gifts from industry says doctors should not accept gifts worth more than $100 and that any gift should benefit patients directly. AMA policy, initiated by the AMA Medical Student Section, says the Association will communicate to medical school deans and residency directors the importance of teaching ethical guidelines. Policy also calls for working with schools to develop rules for medical students, staff and faculty regarding gifts from industry.

Medical schools and hospitals have until Nov. 1 to upload their policies and complete forms for the AMSA scorecard or ask for an extension. Last year’s participation rate was 97%.

“We’re hoping this will be a tool for change, not just for medical education, but for the culture of medicine … to ensure that we’re practicing evidence-based medicine and not marketing-based medicine,” Ramachandran said.