more_vert
BEST practice guidelines to help Australia’s medical schools tackle conflict of interest issues with the pharmaceutical industry may be drawn up following a review calling for improved self-regulation.
Professor James Angus, president of the Medical Deans Australia and New Zealand (the peak body representing medical education in the two countries), said he would address the issue at the next executive meeting of deans later this month.
He was commenting on the results of a survey of 20 Australian medical schools, which assessed their policies regarding disclosure and management of conflict of interest with the pharmaceutical industry, published in the latest MJA.(1)
The survey, conducted in October 2009, used the American Medical Student Association (AMSA)’s PharmFree Scorecard to rate medical schools across seven domains ― gifts, consulting relationships, industry-funded speaking relationships, disclosure, on-campus educational activities, travel to off-campus educational activities and curriculum.
The final scores were based on the AMSA grading system of A for more than 85%, B 70%–84%, C 60%–69%, D 40%–59%, F less than 40%, and in process (development).
The final mean score for Australian medical schools was 44%, compared with 58% for a similar survey conducted by AMSA of American medical schools in 2009.
Of the 20 Australian medical schools surveyed, five had two or more policies in development. Three university medical schools (Melbourne, NSW and Wollongong) did not have policies across any of the seven domains but were in the process of developing them.
Nine medical schools were graded D, and five were graded F, with three of those (Deakin in Melbourne, Adelaide and Notre Dame in Sydney) failing to provide any information.
No medical school attained an A or a B grading and the highest overall score was 67% for James Cook University’s medical school, graded C.
Curriculum received the highest average score (60%), while the domains with the lowest average scores were on-campus educational activities and travel to off-campus educational activities.
“Medical schools should continue to recognise their influential position in society, and be aware that their financial relationship with industry is an area in which they should demonstrate leadership in the quest towards the highest possible ethical standards in medical education and research,” the authors said.
They warned that failure to develop policies could lead to the imposition of legislative controls governing disclosure and management of conflicts of interest.
Professor Angus, dean of medicine at the University of Melbourne, said his medical school had relied on the clinical deans and heads of clinical departments to be custodians of a self-regulating best practice model.
“We need to ensure the balance is right on how staff and students engage with the industry and I am strongly of the view that we must set guidelines, as this paper [proposes],” he said.
Last year his faculty executive agreed to develop a policy framework, which would be completed by the end of this year and cover all health professional courses, students and staff, Professor Angus said.
Professor Peter Smith, dean of medicine at the University of NSW, said although it was true that UNSW was “in process” of developing policy in 2009, they now had policies that covered the domains.
Coauthor of the study Professor Martin Tattersall, professor of medicine at the University of Sydney, said he suspected there would be some reform and further attention to policies as a result of publication of the study.
“And that is very important from the perspective of training the next generation of doctors,” he said.
However, the current generation of doctors employed in universities, hospitals, public health departments and elsewhere also needed to be much more transparent to their employers and patients about their conflicts of interest, Professor Tattersall said.
“I think the current environment is probably doing medicine and the medical profession a fair amount of harm,” he said.
Pharma Phacts, a medical student group committed to raising awareness about pharmaceutical companies, said the study was a serious wake-up call for some of Australia’s medical schools.
James Ricciardone and Dave Carmody, speaking on behalf of the group, said surveys showed most students wanted less influence by pharmaceutical companies on their education, and more instruction about the issue.
– Cathy Saunders
Sir Arthur Amies after research as dean (I think) of Melbourne’s dental school and later others showed (and have yet to be refuted) that WHO and national dental and medical promoters of water fluoridation in the minority of countries fsvouring such medication lacked uniquivocal evidence of its safety and efficacy. They found some involvement of interests selling fluoride in promoting research that tends to shift emphasis to tolerance of moderate florosis from reticulated drinking water, and to turn costly industrial pollutant fluorides into a lucrative by-product.
Any form of regulation can be hijacked by gift-bearing, articulate agents of pharmaceutical companies. Self-regulation has probably got as much chance as any other imposed form. It will succeed when students understand the processes used to recruit them, and feel free to discuss them openly. It is the insidious process whereby a student does not realise his future depends on promoting the company that funded his PhD or the research project he has set his heart on, when he thought his unexpected success had been due to his own efforts. Few young doctors can contemplate destroying their career just as it seems to be getting going. You can’t outlaw the friendly, generous company rep, but you can alert the young doctor to the ploys they use, and the heavy cost of questioning their products as a graduate doctor.
Medical students can be taught to avoid undue influence from pharmaceutical companies. It has been done in a US university study. Having an independent person like an ombudsman for concerned students may also be useful in getting the program going, and ensuring on-going vigilance.
One of the greatest conflicts of interest for medical schools is their relationship with the government health departments. Having been attacked for commenting on the state health system, I know that there is significant ability for politics and commercial interests to hamper free speech and unbiased opinion. Let us have a consistent policy for all commercial interests that impact on universities and medical schools.
Self regulation has indeed failed. It is contradictory to the profit goal. Those in a position of power and influence need to disclose conflicts of interest and allow our burgeoning young medicos to make up their own minds, as we expect of students at this level.
The researchers are also about to learn another important fact: Don’t get between a doctor and a free dinner.
Educational institutions should have no input from commercial vested interests – including Apple for example. Research dependent on industrial support must be suspect if that input is not declared.
Individual medical graduates can then be expected to be rational and balanced in their judgement of any industry’s attempts to influence them or suffer the ridicule of their peers. I do not believe we should, as individuals, eschew industry support for educational meetings. We are adult enough to know they do want to influence and bias our choices just as the government does.
Self-regulation just doesn’t work. It never has and it never will.
As long as we allow universities to write their own policies on the amount of input and financial interest drug companies have in the education of medical students (and honestly, shouldn’t that be NO input?), we will continue to wonder if the doctors of tomorrow are capable of making decisions in their patient’s best interest when they go into practice.
Evidence-based medicine means medicine that is not aligned or tainted by vested interests and that distancing has got to begin in medical school – if not sooner.
This pseudoscience and the fresh revelation that human activity is not pure is increasingly tiresome. Against what gold standard, of what outcome was this AMSA rating validated? What does a score of 58% vs 44% mean? Of course, it means nothing other than a bureaucratic exercise to justify bureaucratic exercises. These kinds of studies serve to deflect attention to “coal face” teachers and whether they have recieved a cream puff for speaking with a pharmaceutical representative rather than where the big money is targetted, higher up the food chain. Pah, Humbug!
Yes let’s get drug companies. What have they ever done for us? Oh wait, that’s right all those medications. Why dont we cure everything with university policies!!!!!!!!
And since when was having a policy a measure of outcome… typical university twaddle.