The New England Journal’s recent series1,2,3 highlights the complex relationship between physician-patient interactions, medical advancements, and industry influence. However, the discussion must go beyond whether doctors can engage in financial relationships with pharmaceutical companies while maintaining objectivity. This is exactly what the Just Medicine campaign of the American Medical Student Association (AMSA) seeks to address.
The work AMSA has done in developing and publishing its scorecard 4 goes far beyond how Dr. Rosenbaum portrayed it. Rather than simply grading schools on their “creation of a pharma-free environment,” the Just Medicine Campaign engages students in assessing conflict-of-interest (COI) policies at their medical schools and teaching hospitals to promote patient-centered, evidence-based clinical practice, medical education, and research. Notably, the methodology used in the scorecard is based on expert task force recommendations, which reviewed COI-related literature, including the recent Pew Task Force on Medical Conflicts of Interest 5. This task force was not limited to medical students — it included medical school administrators, faculty, practicing physicians, and patient advocates.
Resources like the scorecard and the Just Medicine Campaign are not meant to hinder collaboration or innovation. Rather, they empower students and educators to critically evaluate what drives these collaborations and ensure that ethical values and patient care remain at the forefront.
There is no doubt that medical students will be exposed to the pharmaceutical industry throughout their education. In fact, research (6) indicates that this exposure often begins within the first years of training, before students even set foot in a hospital. Given this reality, students must have the opportunity to understand these relationships from multiple perspectives (7, 8). These interactions are a critical part of professional identity formation, shaping how students develop their understanding of of professionalism 9 as they progress from trainees to physicians.
COI is a deeply ingrained issue that extends beyond individual interactions — it is woven into the structure of how medicine operates within an economic framework that often prioritizes profit over patient care. Should we not strive for the highest ethical standards in medicine? The fact that collaboration between industry and physicians can be beneficial does not mean that all such relationships are inherently positive.
Our goal is not to debate Dr. Rosenbaum’s stance on COI point by point. Rather, we must challenge the idea that medical students’ efforts to address COI in their education are inappropriate. We stand by the work AMSA has done and recognize the importance of creating spaces within medical education where COI can be critically examined. We commend the medical students who have taken meaningful steps to advance this essential conversation.
References
- Rosenbaum L. Reconnecting the dots – reinterpreting industry-physician relations. N Eng J Med 2015; 372:1860-1864.
- Rosenbaum L. Understanding bias – the case for careful study. N Engl J Med 2015; 372:1959-1963. Link
- Rosenbaum L. Beyond moral outrage – weighing the trade-offs of COI regulation. N Engl J Med 2015; 372: 2064-2068. Link here.
- AMSA PharmFree Scorecard 2014. http://www.amsascorecard.org, Sterling, VA: American Medical Student Association. 29 May 2015.
- The Pew Charitable Trusts, “Conflict-of-Interest Policies for Academic Medical Centers: Recommendations for Best Practices,” 2013, http://www.pewtrusts.org/en/research-and-analysis/reports/0001/01/01/conflictsofinterest-policies-for-academic-medical-centers
- Kesselheim, Aaron S. “Medical Students’ Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review.” PLOS Medicine, (2011)
- Kesselheim, Aaron S., Austed, Kirsten E. “Conflict of Interest Disclosure in Early Education of Medical Students”306(9) (2006): 991-992
- Stern, David T., Papadakis, Maxine. “The Developing Physician–Becoming a Professional” The New England Journal of Medicine. 355 (2006): 1794-1799
- Wald, HS. Professional Identity (Trans)Formation in Medical Education: Reflection, Relationship, Resilience. Acad Med. 2015;90:701–706. First published online April 15, 2015