April 2008

Med schools fail to adopt conflicts of interest policies

Most US medical schools surveyed have failed to adopt policies on conflicts of interest regarding financial interests held by the institutions, according to a study in the February 13 issue of JAMA.

All too often, a school or its senior officials have a financial relationship with or a financial interest in a public or private company in the medical industry, such as a drug manufacturer.

"Institutional conflicts of interest (ICOI) occur when these financial interests affect or reasonably appear to affect institutional processes. These potential conflicts are a matter of concern because they severely compromise the integrity of the institution and the public's confidence in that integrity," the authors write. They add that these conflicts may also affect research results. The Association of American Universities (AAU) and the Association of American Medical Colleges (AAMC) have recommended policies regarding ICOI.

However, researcher Susan H. Ehringhaus, JD, of the Association of American Medical Colleges, Washington, D.C., and colleagues found that only 38 percent of survey respondents have adopted an ICOI policy covering financial interests held by the institution, 37 percent said they are working on a policy, and 25 percent are not working on adopting such a policy or did not know.

The researchers conducted a national survey of deans of all 125 accredited allopathic medical schools in the U.S., and received responses from 86.

The figures were higher for policies covering conflicts of interest with specific senior school officials although there were still a significant number that did not have policies covering even members of their institutional review boards or governing board members.

More than 20% of the institutions surveyed failed to even address the problem of a research official with financial interests in a research sponsor or with a product that is the subject of research,

"While acknowledging that adoption of ICOI policies is not a simple task and is dependent on, among other factors, highly interactive institutional databases and the active involvement of faculty, administrative officials, and the institution's governing board(s), it is problematic that more schools do not have more comprehensive policies in place," the authors noted.

In an accompanying editorial, David J. Rothman, Ph.D., of Columbia University, New York, commented on the findings.

"It is fair to ask whether it is naive to trust institutions to monitor and discipline their own financial activities, particularly when the financial returns can be substantial. Licensing agreements on patents generate close to $2 billion per year for academic research centers," Rothman noted. "At a time when federal research funding is declining and competition for philanthropic gifts is intensifying, universities may not be eager to promulgate policies that would restrict their freedom to maneuver."