AAMC Reporter: July 2008
Report Pushes for Ban on Industry Gifts
The AAMC Executive Council recently approved a new
report that calls on academic medical centers to prohibit
or severely restrict physicians and trainees from accepting
travel funds, free food, and other gifts and services
from drug and medical device companies.
"Industry Funding of Medical Education, Report of the
AAMC Task Force" offers guiding principles and recommendations
for how medical schools and teaching hospitals
should govern student and faculty interactions
with industry. The report's ultimate objective is to prevent
conflicts of interest that can distort therapeutic
judgments and decision making. The task force that
created the report consisted of medical school and
hospital executives, faculty, medical students, residents, ethicists, and industry CEOs. The report is the culmination
of a 14-month effort by the task force.
The AAMC Executive Committee in April approved the
release of a draft of the report in order to allow members
and other stakeholders to review the content before
final deliberations by the AAMC Executive Council in
June. According to AAMC Chief Scientific Officer David
Korn, M.D., response to the report has been generally
favorable, with members stating that its principles and
recommendations will help pave the way for more scientifically
rigorous and transparent interactions between
academic medicine and the pharmaceutical,
biotechnology, and medical device industries.
P. Roy Vagelos, M.D., task force chair and retired chair
and CEO of pharmaceutical giant Merck, acknowledged
the need for a change in the way industries and medical
schools interact, but added that some relationships were
useful and should continue to exist.
"Every new medicine or device has basic information
discovered at academic medical centers, which is then
taken up into industry and applied," Vagelos said.
According to Korn, the task force took care to distinguish
between those relationships that tended to undermine
the values of professionalism and those that were
evidence-based and promoted principled interactions.
Charles M. Clark, Jr., M.D., associate dean for continuing
medical education at Indiana University School
of Medicine, said it may be counterproductive to cut
off industry interactions completely.
"The task force report was very comprehensive, it addressed
this problem thoroughly, and it came up with
appropriate solutions," he said. "Some people have been
saying, 'we won't take any pharmaceutical monies for
education.' But that may not be the best answer."
John S. Curran, M.D., associate vice president for academic
and faculty affairs at the University of South
Florida College of Medicine, said that the AAMC report
will help advance conversations about industry support
at his institution.
"We plan to use it as a guide as we develop our own
policies," Curran said. He said that it will take time to
develop and implement such a policy, but that he is
optimistic about its effect on tomorrow's doctors.
"Our young can be influenced," he added. "Students and
residents are listening to this."
Mounting evidence showing the effect of gift giving on
decision making helped trigger the task force's formation
in 2006, Korn said.
Although there is a robust body of psychosocial evidence
to the contrary, physicians typically do not recognize
that their judgments are being affected by medical
giveaways. Recent neurobiological evidence has demonstrated
the existence of brain circuits that are activated—without a person's awareness—in response to relationships
of friendship and trust.
Korn noted that although many academic medical
centers still do not have strong policies governing
their interactions with the drug and device industries,
several schools have implemented such policies in the
past few years, including the University of Pittsburgh
School of Medicine; the University of Pennsylvania
School of Medicine; Stanford University School of
Medicine; the University of California, Los Angeles
David Geffen School of Medicine; and Yale University
School of Medicine.
To reduce the likelihood of biased physician decision
making, the report specifically calls for strong limits on
the gratuities and other benefits that commercial enterprises
offer academic medical centers. Food and other
industry gifts provided to students and faculty should
be prohibited, the report states. Academic medical
centers should also prohibit physicians, residents, and
medical students from accepting travel funds to attend
meetings, although reasonable reimbursement for travel
in connection with legitimate contractual services should
be allowed. Pharmaceutical samples should be managed
centrally by the institution, or other measures should be
considered to reduce risks to professionalism inherent in
current practices. Faculty should be strongly discouraged
from participating in industry-sponsored speakers' bureaus.
In addition, ghostwriting, a practice in which companies or
their contractors clandestinely write presentations for faculty
physicians, should be banned, the report states.
Korn said he expects these recommendations to ultimately
transform the way academic medical institutions—and perhaps all medical institutions—interact
with industry. But the recommendations hold special
importance to medical education, where instructors
have long recognized the influence of a so-called "hidden
curriculum" in shaping student attitudes and values,
Korn said. If medical students see their professors
accepting gifts or travel monies as entitlements, they
may be more likely to engage in these practices also.
"Trainees tend to do as we do, not as we say," Korn
said. "Medical schools and teaching hospitals are the
incubators of the next generation of physicians and
scientists, and these industry practices abetted by faculty
and administrators undermine the standards of
medical professionalism."
To replace industry-supported programs and practices,
the report suggests developing new formats for
unbiased educational forums where industry and academia
can freely and transparently exchange information.
In this manner, physicians can learn about the
latest industry developments without creating any
unconscious reciprocity impulses.
—By Elissa Fuchs
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