To the Editors—It is striking that Austad et al1 found no association between an institution’s grade on the American Medical Student Association (AMSA) conflict-of-interest (COI) policy scorecard and its trainees’ behavior and attitudes toward industry—findings which contradict those of contemporaneous studies. For example, King et al found that graduates of medical schools that banned industry gifts were less likely to prescribe newly marketed “me-too” psychotropic drugs than were graduates of programs without such policies.2 And Epstein et al found that “rates of prescribing heavily promoted, brand reformulated, and brand antidepressants in 2009 were lower among post-COI graduates than pre-COI graduates at all levels of COI restrictiveness.3
Of note, Austad et al did show that a majority of medical trainees are critical of the pharmaceutical industry’s marketing strategies, up from 2005, when Sierles et al found that fewer than a quarter of third-year medical students supported separation between the pharmaceutical industry and trainees.4
To make progress in enhancing objectivity and integrity in medical education, we must take a multifaceted approach, including both adoption and meaningful enforcement of strong conflict-of-interest policies, along with improved education of trainees and faculty on the clinical consequences of industry influence.
References
Austad KE, Avorn J, Franklin JM, Kowal MK, Campbell EG, Kesselheim AS. Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey. JGIM. 2013. doi:10.1007/s11606-013-2361-0.
Marissa King, Connor Essick, Peter Bearman, Joseph S. Ross. “Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis,” BMJ. 2013: 1-9.
Epstein AJ, Busch SH, Busch AB, Asch DA, Barry CL. Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing? Med Care. 2013;51(2):199–203.
Sierles F, Brodkey A, Cleary L, McCurdy F, Mintz M, Frank J, Lynn D, Chao J, Morgenstern B, Shore W, Woodard J. Medical students’ exposure to and attitudes about drug company interactions: a national survey. JAMA. 2005;294(9):1034–1042.
Conflict of Interest
The signatories represent organizations comprising the Partnership to Advance Conflict-Free Medical Education, a coalition that works with medical schools and teaching hospitals to strengthen their policies regulating interactions with the pharmaceutical and medical device industries.
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Ramachandran, R., Hams, M. & Silver-Isenstadt, J. Physician Trainees’ Interactions with the Pharmaceutical Industry. J GEN INTERN MED 28, 1266 (2013). https://doi.org/10.1007/s11606-013-2527-9
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DOI: https://doi.org/10.1007/s11606-013-2527-9