UCSF was one of just nine medical schools nationwide to receive an A grade in a recent report evaluating how well academic medical centers govern drug industry interaction with their students, faculty and physicians.
The 2009 PharmFree Scorecard, released in June by the American Medical Student Association (AMSA) and the Prescription Project, compared the conflict-of-interest policies of 149 medical schools and awarded 45 schools a grade of A or B – up from 29 schools last year. UCSF’s policy earned an A in 2008 as well.
Despite increased public scrutiny and efforts by state and federal lawmakers to limit industry influence over health care providers, drug and medical device companies continue to provide physicians with billions of dollars’ worth of free samples, free food, free medical refresher courses and other perquisites every year.
In an effort to preserve the independence of clinical decisionmaking, educational curricula and research programs across the 10 UC campuses, the UC Office of the President in 2008 published the University of California Health Care Vendor Relations Policy, a conflict of interest policy that governs all UC employees.
In addition, UCSF has several of its own policies and guidelines that apply variously to the campus at large, the School of Medicine, UCSF Medical Center, Graduate Medical Education (GME) and Continuing Medical Education (CME).
These policies together make “a very strong package,” said Robert Baron, MD, MS, associate dean for GME and CME and professor of medicine.
Advantages and Risks
A realistic, sustainable conflict-of-interest policy is one that goes to great lengths to guarantee transparency in all interactions with industry, while at the same time acknowledging the important role that industry relationships play in the translation of scientific discoveries into widely available medical therapies, Baron said.
“Collaboration with industry has important advantages for UCSF and the community, but also has important risks that must be addressed,” he said. “In education, we need to have very strong firewalls that ensure the separation of education and industry promotion and influence.”
In CME, UCSF has developed practices that go beyond the national accreditation requirements to prevent biased education, including a free online course, “Marketing of Medicines,” which offers an in-depth look at the pharmaceutical industry’s marketing techniques, as well as its effects.
Such efforts have not gone unnoticed. Surveys of participants in a variety of UCSF CME activities found that 97 percent believed that the activity in question was free from any evidence of commercial bias, Baron said.
“Similarly, our GME policy defining and limiting interactions with vendors is as strong as any in the nation,” he said.
Baron said he was “very pleased” by UCSF’s continued, strong performance in the AMSA rankings, and that it reflects “the results of several years of hard work by many people.”
The AMSA scorecard rated about a dozen elements of the School of Medicine’s conflict-of-interest policy, including gifts and meals, on-campus education, and industry-funded speaking relationships, and gave the University top marks for most of them.
“With several excellent policies and a strong foundation, University of California San Francisco School of Medicine has a substantial overall conflict of interest policy,” the final report stated.
More Work to Do
UCSF and various other academic medical institutions may have come a long way toward addressing and avoiding conflict of interest, but there are still many changes that must be made on a national scale, reformers argue.
In a strongly worded report released in April by the Institute of Medicine (IOM), a committee of health professionals and experts in medical ethics stated that “the current system of [industry] funding is unacceptable and should not continue.”
The committee, led by Bernard Lo, MD, UCSF professor of medicine and director of the University’s Program in Medical Ethics, included Lisa Bero, PhD, UCSF professor of clinical pharmacy, and Deborah Grady, MD, MPH, professor of medicine as well as associate dean for clinical and translational research and director of the UCSF Women’s Health Clinical Research Center.
When it comes to medical education, the risks created by financial relationships with industry offset the potential benefits, the committee asserted.
“It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy,” the report said.
Bero, who has served on numerous national and international committees related to conflict of interest and research, said she is pleased UCSF’s policies are already in line with the IOM recommendations, and she praised the student body for its strong support of such rigorous standards.
“Students have had a lot of say in pushing forward our policy,” she said, a trend she believes could lead to similar changes on other medical school campuses.
In addition, Bero and her fellow IOM committee members have called on Congress to pass legislation making industry influence and relationships more transparent.
A bill introduced in January by Senators Charles Grassley of Iowa and Herb Kohl of Wisconsin would require drug and medical device makers to publicly disclose all payments above $100 made to physicians. The Physician Payments Sunshine Act of 2009 is currently being reviewed by the Senate Finance Committee.
As the conversation continues at all levels, UCSF will remain an active participant, and as standards and best practices evolve, so will the University’s own guidelines, Baron said.
“It is our goal at UCSF, in GME and across the campus, to continue to educate ourselves and each other regarding the key elements of [conflict-of-interest] policy,” he wrote in the March issue of the Residents Report, GME’s quarterly newsletter. “In the meantime it is up to each of us, in the name of professionalism, to abide by these standards.”
Guidelines for Interactions Among UCSF Faculty, Residents, Fellows, and Staff and Industry
(Effective Sept. 22, 2008)
PharmFree Scorecard 2009
American Medical Student Association
“Marketing of Medicines” Online Course
UCSF Office of Continuing Medical Education