AMSA Pharm-free Scorecard 2018

Executive Summary

Updated October 24, 2016; Additional updates will be published at the conclusion of the 2018 analysis

This document reflects school assessments as of the above date. For the most current assessments, please reference the main Scorecard page.

Why we need a Scorecard:

The American Medical Student Association (AMSA) launched the first PharmFree Scorecard in 2007 with the 2018 Scorecard being its ninth iteration. Since its inception, the AMSA Scorecard team has been committed to objectively evaluating conflict-of-interest policies and curricula at the 187 allopathic and osteopathic medical colleges in the United States and Puerto Rico.

The Scorecard is an evolving tool that uses letter grades to assess schools’ performance in fourteen potential areas of conflict of interest. It offers a comprehensive look at the changing landscape of conflict-of-interest policies across U.S. medical education, as well as in-depth assessments of individual policies that govern industry interaction between students, faculty, and the pharmaceutical and medical device industries.

While the relationships between academic physicians and industry benefit medical research and treatment, they can bias medical education in favor of specific products. Studies have shown that industry influence—whether in the form of gifts, commercially supported education, or simply visits with pharmaceutical representatives—can lead to more expensive and less evidence-based prescribing practices.  Medical schools and academic medical centers have been leaders in setting new standards for policies on potential conflicts of interest, as supported by strong guidelines set by the Association of American Medical Colleges (AAMC) in 2008 and the Institute of Medicine in 2009.  In 2012, The Pew Charitable Trusts continued this tradition by convening an expert task force of leaders from academic medical centers to create a new set of recommendations for best practices in conflict of interest policies at academic medical centers.

AMSA revised its Scorecard to reflect many of the recommendations of this task force.  These changes represent an intentional strengthening of the standards of excellence with which policies are evaluated and scored. With the impending release of a federal database disclosing all financial relationships between physicians and industry, greater scrutiny of the appropriateness of these certain industry activities is particularly critical.

The new Scorecard adds three categories not present in prior years, including:

  • Extension of COI policies to community affiliates;
  • Ghostwriting and honorary authorship; and
  • Enforcement and Sanctions of Policies.

Moreover, Site access to pharmaceutical sales representatives and medical device representatives are now scored as two separate domains.

Some institutions will notice a decline in their grades this year, because the new scorecard envisions an ideal, conflict-free medical education environment—one that will not be easy for all medical schools, even those with good policies, to achieve. Through its Scorecard, AMSA seeks to encourage schools to adopt aspirational standards in conflict of interest regulation.

You can also download archives of the 2008, 2009, and 2010, and 2014 policy assessments. For policy assessments for 2016, please contact amsa@amsa.org. Next Scorecard will be released in 2018.

Summary of Results:

As of September 1, 2016, 90 medical schools completed our submission form indicating their policies were still current or submitting new policies to AMSA for Scoring. This was a 52% response rate, increased from 48% the 2014 Scorecard update. In order to continue our tradition of serving as a comprehensive database of U.S. medical schools, we nevertheless scored non-reporting schools by searching for publically available documents online (see Methodology for more details.)

Of the 173 US medical schools, 42 receive “A”s (24%), 76 “B”s (44%), 28 “C”s (16%), and 28 Incompletes (16%) In general, schools’ conflict of interest policies fall into three major categories of policy quality:

  1. Excellent or model policies (A) in which at least half of the 14 conflict of interest domains met criteria for best practices (a domain score of 3 out of 3);
  2. Good or solid policies (B), in which at least all 14 domains met criteria for good practices (a domain score of 2);
  3. Poor or deficient policies (C), in which more than one domain scored as a poor practice (1).

In addition, 28 schools (16%) received “I” for Incomplete. These were schools that either did not submit policies, and for which our web search yielded incomplete policies or schools that submitted policies that do not cover all domains.   These institutions are encouraged to share updated policy information with AMSA for a possible re-grade.

Trends and Analysis:

This year, the percentage of schools receiving a top grade of A increased from 17% to 24%. In 2014, 67% of schools received either an A or B rating. This year, the percentage remains virtually unchanged at 68% even with the inclusion of 12 additional schools into the Scorecard. Consistent with the more stringent criteria of this year’s Scorecard, fewer schools received grades of A or B this year than last: In 2013, 72% of schools received the top two grades, whereas in 2014 this proportion dropped slightly to 67%. This overall decrease was entirely due to a drop off in the number of A grades (40 in 2013, and 27 in 2014). In fact, the number of schools with solid B policies increased from 74 in 2013 to 81 this year.

Similar to the 2014 Scorecard, no school received a perfect 100. Nonetheless, several institutions deserve particular attention for the submission of extremely strong policies: Florida International University Herbert Wertheim College of Medicine, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Indiana University School of Medicine, and University of Chicago Division of the Biological Sciences The Pritzker School of Medicine. This year, these 4 schools each received a total score of 96 indicating that all but 2 domains were found to be consistent with AMSA’s top criteria.

“B” policies on the verge of excellence

Many of the solid B schools’ policies would reach “A” status with relatively minor improvements. For example, 13 “B” schools with particularly strong policies narrowly missed model status because only 6, rather than 7 (half), of their COI domains had perfect scores.

Depending on the school, one of the following relatively minor policy adjustments would propel them from a B to an A score:

  • Requiring faculty to disclose their conflicts of interest directly to students and trainees
  • Requiring faculty to pay for their own meals in the context of industry supported continuing medical education activities
  • Discouraging faculty and trainee attendance at industry marketing programs

Trends by Domain:

This year, all domains retained the same criteria from 2014 Scorecard and therefore allow year to year comparisons.

Two domains were essentially unchanged from prior years and therefore allow year to year comparisons: industry-funded promotional speaking and site access for pharmaceutical sales representatives.

  • Gifts: A perfect score requires no industry-funded gifts of any nature or value, including textbooks even if paid for indirectly through a department.Gifts perfect score 2016: 94, up from 79 in 2014.
  • Meals: A perfect score requires that no industry-funded meals of any nature or value are allowed, including indirect industry-funded meals in the context of CME courses.Meals perfect score 2016: 42, up from 24 in 2013.
  • Industry-funded promotional speaking: A perfect score requires that faculty are prohibited from engaging in promotional speaking for industry. Since 2008 this domain has seen steady improvements. This year, 84 schools now effectively ban their faculty from serving on industry promotional speaker’s bureaus. In 2014, 79 schools scored perfectly, up from 44 in 2013, 31 in 2011-12, 19 in 2010, 10 in 2009, and 4 in 2008.
  • Industry funding of CME: A perfect score requires no industry funding for the support of accredited CME except in clearly defined circumstances, such as through a central, undesignated, blinded pool of funds.Industry funding of CME perfect scores 2016: 26, up from 5 in 2014.
  • Attendance of Industry-Sponsored Promotional Programs: A perfect score requires prohibition or discouragement of faculty, students and trainees to attend promotional programs.Attendance of Industry-Sponsored Promotional Programs perfect score 2016: 32, up from 25 in 2014.
  • Scholarships: A perfect score requires that schools not accept industry funds for sending medical students to conferences. Prior to 2014, industry funding was deemed acceptable as long as the funder had no role in selection of recipients and 123 schools received a top rating. In 2014, Only 3 institutions had policies that prevented industry funding. This year, several additional schools have strengthened their policies.Scholarship perfect scores 2016: 16, up from 3 in 2014.
  • Ghostwriting and honorary authorship: A perfect score requires prohibition of this activity. This domain was introduced to the Scorecard in 2014 and many schools were found to have strong policies.Ghostwriting perfect score 2016: 113, up from 105 in 2014
  • Consulting and Advising Relationships: A perfect score requires prohibition or active discouragement of consulting or advising for purely commercial or marketing purposesConsulting and Advising Relationships perfect score 2016: 40, up from 25 in 2014.
  • Pharmaceutical sales representative access: 20 schools now either forbid site access to pharmaceutical sales reps, or have policies in place effectively preventing them from engaging in marketing activities. This continues to improve from 9 in 2014, 4 in 2013, 2 in 2011-12 and 2010, and 1 in 2009 and 2008.
  • Medical device representatives: A perfect score permits representatives in patient care areas only for legitimate reasons not related to marketing, such as providing necessary technical assistance and/or training on devices or other equipment already purchased.Medical device representatives perfect score 2016: 105, up from 91 in 2014
  • Disclosure: A perfect score requires internal disclosure to the institution and external disclosure to trainees/audiences.Disclosure perfect score 2016: 65, up from 51 in 2014
  • COI Curriculum: A perfect score requires a medical school curriculum that reflects and covers most of the curricular content and objectives in the AMSA standards for a “model curriculum.”COI Curriculum perfect score 2016: 44, up from 34 in 2014
  • Extension of COI policies to adjunct faculty and affiliated institutions: A perfect score requires the policies to apply to all employees of the institution, whether full/part-time or volunteer faculty and students/trainees. The policy must apply to them regardless of the site they are working, even if the site itself does not follow the same policy.Extension of COI policies perfect score 2016: 72, up from 50 in 2014
  • Enforcement and sanctions: A perfect score requires general oversight to ensure compliance with policies and sanctions for noncompliance.Enforcement and sanctions perfect score 2016: 131, up from 126

The following is a streamlined list of all 2014 domains and the number of schools receiving perfect scores in each:

  • Gifts – 94
  • Meals – 42
  • Industry-funded promotional speaking relationships (not ACCME-accredited) – 84
  • Industry-support of ACCME-accredited CME – 26
  • Attendance of industry-sponsored promotional events – 32
  • Industry-supported scholarships and awards – 16
  • Ghostwriting and honorary authorship – 113
  • Consulting and advising relationships – 40
  • Access of pharmaceutical sales representatives – 20
  • Access of medical device representatives – 105
  • Conflict of interest disclosure – 65
  • COI curriculum – 44
  • Extension of COI policies to community affiliates – 72
  • Enforcement and Sanctions of Policies – 131

Methods

For full report see the Methodologies Section