Monday, April 28, 2008

The AAMC Has Spoken: The (More or Less) Pharm-Free Medical Center

A task force of the Association of American Medical Colleges today released its report on "Industry Funding of Medical Education." See Gardiner Harris's report for the New York Times at, and the report itself at

We'll turn in a minute to the details, but first the news headlines. What seems most astonishing about the report is that several highly placed CEOs of major drug and biotech firms served as members of the Task Force, which was chaired by Dr. Roy Vagelos, former Merck CEO (albeit a CEO who has been widely quoted as dismayed by what commercialism has done in recent years to his once-proud company). Nonetheless the report recommends the cessation or severe curtailment of most commonplace industry marketing practices. True, several of the company guys dissented from one or another aspect of the report. But taken as a whole, their dissents were relatively tame and peripheral. It's not clear to me whether these CEOs truly believe that when looked at in the cold light of dawn, many common industry practices are indeed indefensible; or whether they figure that with all the PR hits the industry is now taking, the better part of valor is to head for cover.

Now for the details (based on the executive summary):

  • Industry activities that undermine professionalism need to be eliminated.
  • Trainees need to be educated as to the challenges to professionalism posed by industry interactions (and a follow-on group should specifically address educational methods and objectives).
  • Academic medical centers should try at least by persuasion if not by enforcement to make the rules binding off-site and off-hours as well as on the campus itself.
  • No gifts from industry to individuals. Food is a gift, unless a meal is part of an audited and prescribed CME activity.
  • Drug samples should be centrally controlled if used at all.
  • Drug reps on campus by appointment only, and not in patient care areas.
  • No drug rep contact with trainees unless directly supervised by faculty.
  • Device reps in patient areas only if needed for direct teaching or adjustment of device use.
  • Centers need to carefully audit that CME programs meet ACCME guidelines.
  • Faculty participation in industry speakers' bureaus should be strongly discouraged.
  • Industry may provide educational grants for trainees only if medical center has full control over selection of recipients.
  • Ghostwriting is prohibited.

Quibbles? There are several places where some wiggle room is allowed, where I personally would have preferred a strict "no," pure and simple. As the report focuses on "education," nothing is said about the biggest temptation for faculty and institutions alike--industry research grants to do drug studies.

Is this document important? Let me use my own home base as an example. The University of Texas Medical Branch is now the proud owner of a very strict conflict-of-interest policy, courtesy the University of Texas System governance structure, which dictated to us that such policies would be adopted at all UT health science centers, pronto. The policy was just recently approved and is to go into effect July 1. The Provost, very appropriately in my view, promised the faculty opportunities between now and July 1 to voice their views on the policy and perhaps to amend it. The view in the trenches among my colleagues, as voiced at previous forums on this topic, tended to favor laissez-faire on the matter of drug company gifts and payments. I don't believe that most of the faculty even know yet about the new policy, and I was looking for a convenient foxhole to hide in when the shells started flying. But now, in the face of this new AAMC policy statement, I have a hard time seeing how any faculty member, who would wish to loosen the strictures of the policy, would really have a leg to stand on. So yes, I think this is an important development. Let's meet up in 5 years and see how much has changed as a result.

1 comment:

Roy M. Poses MD said...

But, after a quick read, I am not so optimistic.

As I posted on the Carlat Psychiatry Blog, the report does not suggest banning participation on speakers' bureaus, it just discourages it. The report puts no restrictions on company sponsored CME as long as it is accredited (and we know that accredited CME done by a MECC but sponsored by a commercial firm is often biased). Not not only does the report not ban larger conflicts of interest (consulting agreements, service on advisory boards, service on corporate boards of directors), it seems to encourage them, and does not even suggest disclosure (see page 23).

I will likely be blogging about this soon myself.

But at a school following all provisions of this report, a resident might be banned from accepting a slice of pizza from a company on whose board his or her department chair (or dean of medicine, or CEO of the medical center, or university president) sits.

By the way, not only were some of the authors of this AAMC report pharma or device executives, some other authors listed as academics are also directors of large for-profit health care corporations.

The AAMC did not see fit to disclose any potential conflicts of interest affecting the authors of this report.

It all seems a bit hypocritical, doesn't it?

I guess a glass half empty is better than an empty glass, but still, ...