Medical school gets ‘D’ on annual report card

When Elliot Dickerson set foot inside Temple’s School of Medicine, he came armed with a mission beyond his own academic goals.

“[To address] conflict-of-interest policies was one of the reasons I came to Temple,” said Dickerson, a second-year medical student. “It’s something close to me.”

In 2008, the American Medical Student Association issued its second PharmFree Scorecard, a report that issued letter grades to medical schools across the country based on each institution’s policy regarding its regulation of interaction between each campus’ faculty and the pharmaceutical industry.

Of the 151 medical campuses graded in the Scorecard, 76 of those received less than an average C grade – including the School of Medicine, which received a D.

The Scorecard offers a breakdown of each college’s grade and suggestions as to what it can do to strengthen its policies. While the school’s faculty is currently drafting a policy, there wasn’t much for AMSA to grade – there is no formalized conflict-of-interest policy for faculty at present.

Because faculty members are not currently required to disclose information regarding their relationships with the industry, there is no way of knowing how much money has flowed into the university directly as a result of pharmaceutical marketing.

A source who asked not to be identified said while it is not a widespread problem, there are physicians in the School of Medicine who accept gifts from the pharmaceutical industry.

The Physicians Payment Sunshine Act, a bill reintroduced to the U.S. Senate in January 2009, would require any drug, biologic or medical device manufacturer to disclose certain “transfers of value” made to physicians. Required disclosure would then be archived online in a public directory. Companies failing to report would be penalized financially.

“While it is a natural interaction,” said Dr. Joanne Orth, senior associate dean of Faculty Affairs, “the important thing is that all transactions be transparent. I don’t think I’m prejudiced to say that our faculty is of integrity.”

As a worker in a primary care setting at the University of Colorado, Dickerson said he witnessed unrighteous ties between physicians and pharmaceutical companies.

“Rather than the most important or effective drugs, [prescriptions] were driven by what pharmaceutical companies were pushing,” Dickerson said.

When he arrived at the School of Medicine, Dickerson became a member of Temple’s chapter of AMSA, a national student-run organization that aims to improve health care and education, including moral and ethical obligations.

Along with five other conflict-of-interest-conscious members of AMSA, Dickerson drafted the school’s Guidelines Regarding Student Interaction with Pharmaceutical Marketing Representatives.

The set of guidelines, which was proposed Feb. 23 and should be in effect by April, addresses many of the same factors for students that the PharmFree Scorecard suggests for campus faculty, Dickerson said.

The guidelines state the school “has recognized that excessive and inappropriate marketing practices, especially when directed at students, are often contrary to the spirit of [the medical profession’s] commitment to evidence-based medicine and diverts billions of dollars away for the research and development that drives the innovation that ultimately leads to better patient care.”

Specifically, the guidelines encourage students not to accept gifts – including drug samples, dinners, supplies or any other form of monetary compensation – from representatives of pharmaceutical or medical device manufacturers, in exchange for attending their respective marketing presentations or to attend continuing medical education events.

Additionally, the new student guidelines address the medical school curriculum, stating that students should not be required to attend lectures for a grade where pharmaceutical or medical device representatives are actively marketing their products.

The guidelines also propose that conflicts of interest in medicine should be enhanced in the school’s curriculum.

“We wanted to draft a policy that we felt addressed issues that students felt strongly about,” Dickerson said.

Once the draft was completed, AMSA presented it to Temple Student Government and the administration. It was approved by the clerkship directors.

“The administration was very supportive,” Dickerson said. “But it still took a great amount of effort.
“It’s unfortunate because as students, we can’t force [policies] on faculty. We can only regulate our actions as students.”

Still, Dickerson remains hopeful, and rightfully so.

Orth has been drafting a formal conflict-of-interest policy for the faculty since Fall 2008.

“It’s important that [students] get the right mindset of what’s appropriate and what’s not because the pharmaceutical industry spends a lot of money on marketing,” Orth said.

Orth said she took numerous factors into consideration while drafting the document, including model conflict-of interest policies of around 25 other schools, like that of the University of Pennsylvania, which received an A grade for its policies on the PharmFree Scorecard.

“I’ve reviewed Penn’s policy in detail, and ours will be just as comprehensive,” said Orth, adding she thinks Temple will receive an A or a B next year.

According to the PharmFree Scorecard, while the School of Medicine currently does not allow faculty to serve on speakers bureaus, it should strengthen its policies by addressing “gifts beyond the weak [American Medical Association] guidelines on gift acceptance, system-wide disclosure, site access and industry provision of scholarships.”

Orth said the new policy would cover all of the above.

The formal policy will be comprised of many of the same rules set forth in the student guidelines regarding pharmaceutical industry gift acceptance, as well as medical curriculum. It will also cover all guidelines set by the American Association of Medical Colleges, Orth said.

A noticeable implement of the policy would be the regulation of acceptance and use of pharmaceutical samples and office supplies.

One of the major components of the new policy will be that the faculty will be required to fully disclose interaction with the pharmaceutical industry, Orth said.

The school’s policy has been reviewed and has received input from Dean John M. Daly, and his advisory committee.

Daly and Orth will present the policy to the provost within the next few weeks, and the policies should be in full effect within the next academic year, Orth said.

While AMSA and Dickerson will keep an eye on the faculty’s new policy, their overall reactions are positive.

“As long as it’s comprehensive, I think it’ll be beneficial,” Dickerson said. “[Conflict-of-interest policy] enhances trust between faculty and med students. The quality of our medical education will be much better.”

Maria Zankey can be reached at maria.zankey@temple.edu.