Executive Summary Updated March 7, 2012

This document reflects school assessments as of the above date. For the most current assessments, please reference the main Scorecard page, as well as the Latest News page for a listing of updates as they occur.

Why we need a Scorecard:

Since 2007, the American Medical Student Association (AMSA) PharmFree Scorecard, now in its fifth iteration, has evaluated the conflict-of-interest policies at the 152 allopathic and osteopathic medical colleges in the United States and Puerto Rico.  

Over the past 10 years, there has been a growing public outcry over conflicts of interest, both real and perceived, that are occurring throughout the healthcare industry.  The public, policymakers and medical professionals have been increasingly focused on the potential for these conflicts to influence medical care, with profit potentially taking precedence over the interests of patients. In the forefront of this discussion has been how to balance the benefits of industry partnership with the risks of industry marketing adversely impacting medical care, clinical research and medical education. Medical schools and academic medical centers have been leaders in setting new standards for policies to regulate potential conflicts of interest, as supported by strong guidelines set by the Association of American Medical Colleges (AAMC) in the summer of 2008 and the Institute of Medicine in spring 2009.  

The Scorecard is an evolving tool which assesses the policies of academic medical centers and medical schools in regard to the interaction between students or faculty and the pharmaceutical industry. Using letter grades to assess schools’ performance in eleven potential areas of conflict, the Scorecard offers a comprehensive look at the changing landscape of conflict-of-interest policies across American medical education, as well as a more in-depth assessment of individual policies that govern industry interaction. The major focus of the Scorecard is to examine the potential for conflicts of interest to impact medical education at the level of the trainee. Of note, the AAMC guidelines noted above also address institutional and research conflicts of interest that are not addressed specifically in the AMSA PharmFree Scorecard.

For an archive of the 2008, 2009 and 2010 policy assessments, please go to the bottom of the main Scorecard page at www.amsascorecard.org and click on 2008, 2009 and 2010 Policy Archive.

Click a year link to display previous annual assessments (2011-12 is default): 2011-12 | 2010 | 2009 | 2008 

 

 

Summary of Results:

As of March 7, 2012, 149 of 152 medical institutions considered eligible for grading have participated in the Scorecard, a 98% participation rate, improved from 92% in 2009.   

Of these 152 US medical schools, 28 receive “A”s (18%), 74 “B”s (49%), 15 “C”s (10%), and 13 “D”s (9%).

Nine schools (6%) receive a grade of F. This includes three schools that submitted policies graded as F, three schools that stated they had no conflict of interest policy in place, and two that did not respond to repeated attempts at follow-up in 2008, 2009, 2010 and 2011-12. One additional school received an F as they did not submit new policies or demonstrate a continuing policy development process after remaining In Process for one year.

Assigning a score of F to the three schools which have not submitted policies may slightly overestimate the true prevalence of inadequate policies. Nevertheless, it seems likely that most of the schools that have chosen not to participate do not have strong policies.

Two schools received a grade of In Process due to ongoing policy development with completion expected in the next three months. An additional nine schools were granted In Process designations for pending assessments.  One school (a new school participating for the first time) was granted an extension to submit their policies late and an additional four schools that matriculated their first students in either 2010 or 2011 remain in the two year grace period for new schools.
 

 

Trends and Analysis:

In 2011-12, for the first time over two-thirds of medical schools, now have grades of A or B. Similar to 2010, this is yet another tremendous year-to-year increase in schools with "model" policies.  In 2010, there were 79 A and B schools (52%) and over 45 A and B schools (30%) in 2009 compared to 102 today. This demonstrates a new baseline for the management of conflict of interest in academic medical centers in the United States.

Approximately one quarter of U.S. medical schools improved their conflict-of-interest policies since the 2010 Scorecard was released in December 2010.  34 of these schools improved their scores to a B or above after submitting updated policies for review.

There are a number of schools who have made great strides this year. Of particular note, however, is the A grade achieved by Harvard Medical School this year. Harvard has been home to a great deal of student activism over the past 4 years in regards to the management of its significant conflicts of interest.  After initially receiving an F grade in 2008, they improved their score in 2009 to a B.  Now they have one of the strongest policies in the country that includes a ban on speakers bureaus in addition to a strong gift, disclosure and samples policy.

Fifteen schools with previous failing grades participated since the release of the 2010 Scorecard.  Four schools deserve particular attention for submitting significantly improved policies which increased their scores from Fs to Bs. These schools are: University of Texas Health Science Center at Houston, University of South Carolina, Howard University, and Morehouse School of Medicine. In addition, five other schools improved at least 2 letter grades: Eastern Virginia Medical School, University of Arizona College of Medicine, Midwestern University- AZCOM Arizona College of Osteopathic Medicine and CCOM (Chicago), University at Buffalo, and OU-COM Ohio University – College of Osteopathic Medicine

Trends by Domain:

The number of model (a grade of 3 on a scale of 1 to 3) scores increased in almost every domain graded by the Scorecard. As has been the experience in the past, the areas that garnered the greatest number of perfect scores were those addressing industry support of scholarships, off-campus continuing medical education, purchasing, and gifts. However, it appears that the rapid increases seen in schools adopting model policies is naturally leveling off as there becomes fewer and fewer schools with less than ideal policies.  New areas of growth appear to be seen within the following three domains: curriculum, speaking, and consulting. Specifically, curriculum experienced the largest net growth in new schools with model policies (22 additional schools).  Speakers relationships and consulting experienced an increase in an equal number of schools (16 schools) and the scholarships, gifts and off-campus education experienced large increases as well.

One area deserving of particular attention is the growth in ideal policies on speaking arrangements. Seventeen of the thirty-two schools with ideal policies on speaking arrangements took the lead by explicitly banning participation by their faculty on speakers bureaus.  These schools are: Harvard Medical School, New York University School of Medicine, Duke University School of Medicine, Columbia University College of Physicians and Surgeons, University of Arkansas, University of Maryland, Georgia Health Sciences University, University of South Carolina, University of Hawai’i John A Burns School of Medicine, Wake Forest University School of Medicine, University of Massachusetts, Emory University School of Medicine, Stanford University School of Medicine, Albert Einstein College of Medicine, University of Alabama Birmingham, University of Florida and Jefferson Medical College.

Once again, on-campus continuing medical education and interaction with sales representatives remain challenging areas.  In regards to industry sales representatives, there was no change this year and there continue to only be two academic medical centers receiving a perfect score; University of South Dakota Sanford School of Medicine and Florida State University College of Medicine, both of which have limited clinical facilities.
 

The following is a list of domains and the number of perfect scores in each:
    •    Scholarships – 108; improved from 94 in 2010, 66 in 2009 and 29 in 2008
    •    Off-campus continuing medical education –  88; improved from 75 in 2010, 49 in 2009 and 23 in 2008
    •    Gifts & Meals– 81; improved from 66 in 2010, 44 in 2009 and 19 in 2008
    •    Purchasing – 70; improved from 65 in 2010, 47 in 2009 and 22 in 2008
    •    Curriculum – 69; improved from 47 in 2010, 28 in 2009 and 12 in 2008
    •    Consulting – 64; improved from 48 in 2010, 27 in 2009 and 12 in 2008
    •    Speaking – 32; improved from 18 in 2010, 10 in 2009 and 4 in 2008
    •    Samples – 31; improved from 26 in 2010, 20 in 2009 and 12 in 2008
    •    Disclosure – 29; improved from 20 in 2010, 5 in 2009 and 1 in 2008
    •    On-campus continuing medical education – 20; improved from 15 in 2010, 3 in 2009 and 5 in 2008
    •    Sales representatives – 2; unchanged from 2 in 2010, and both 1 in 2009 and 2008

 

Regional Trends:

Californian medical schools continued to excel with 7 of their 10 schools receiving an A grade.  This is in part due to the strong system-wide University of California (UC) conflict of interest policy, which when graded on its own, receives an A grade.  However, some of the UC schools (UCLA, UC Irvine and UCSF) go even further by adding their own policies onto this. In addition to the UC schools: Stanford maintains an A grade, Loma Linda University Adventist Health Sciences Center keeps its B, and Touro College of Osteopathic Medicine still has a C grade. Western University submitted policies to the Scorecard for the first time this year, and these are currently being reviewed, resulting in an In Process grade.

Massachusetts continues to show strong policies. Tufts now has company at the top, with Harvard how having an A grade as well.  University of Massachusetts Medical School has a B, after being In Process during last Scorecard.  Boston University, a former B school,  is now In Process having submitted new policies this year.

Texan schools continue to show significant improvement.  All eight Texan medical schools score at least a B.  University of Texas Medical Branch at Galveston, however, remains the lone A in the Lone Star state.  As described above, University of Texas Health Science Center at Houston, boasts one of the most improved policies in the country.

Another major training ground, New York, continues to showcase schools with model policies. This year, Albert Einstein has joined Mount Sinai School of Medicine in receiving an A grade.  University of Buffalo boasts an impressive improvement from D to B, as noted above.  Albany Medical College, New York Medical College, SUNY Upstate, New York University School of Medicine, University of Rochester Medical Center School of Medicine, and Columbia College of Physicians and Surgeons all received B grades.  Touro College of Osteopathic Medicine - New York received a C grade.  Stony Brook University was formerly a D institution, but that is likely to change as a new policy has been supplied and is currently under review.  Two schools in the state fail to measure up to the competition however.  Weill Medical College of Cornell University continues to have a D grade and New York College of Osteopathic Medicine of the New York Institute of Technology is one of the few non-responders left in the country, and continues to receive an F grade as a result.  Of note, SUNY Downstate submitted a new policy just before the release of the 2011-12 Scorecard and, while their current grade has been changed to an I on their school-specific page, they have been statistically analyzed according to their old grade, which was a D.

The nine Pennsylvania medical schools have strong policies with the University of Pittsburgh Medical Center and the University of Pennsylvania leading the way with A grades.  The remaining schools received 4 B's, a D, and an F.  An I was given to the new medical school: Commonwealth College in Scranton, PA, which is submitting its first policy to the Scorecard this year. In neighboring Ohio, the 8 Ohio medical schools showed continued improvement with 4 Bs, and 3 Cs.  Notably, Ohio University had a significant improvement as noted above.

Finally, the state of Florida continues to perform well. University of Miami’s Miller School of Medicine received the first A grade in the state in 2010, and has now been joined by the University of Florida.  Otherwise, the state has 4 B schools and 1 other school, the recently founded Florida International University Herbert Wertheim College of Medicine, receiving an In Process in their first year of eligibility for grading.  Of note, Lake Erie College of Medicine, which has received an F, has a branch campus in Bradenton, FL.

Methods:

For full report see the Methodologies Section

The PharmFree Scorecard methodology was developed jointly by AMSA and the Pew Prescription Project, an initiative of the Pew Health Group.  Assessed domains are broadly consistent with those identified in recent literature – primarily Brennan et al. Health Industry Practices that Create Conflicts of Interest:  A Policy Proposal for Academic Medical Centers.  JAMA 2006; 295(4): 429-433. A qualitative decision-tree instrument is used to capture key criteria within each domain.  

 

The Scorecard assesses policies related to: acceptance of gifts and meals from industry; consulting relationships; speaking relationships; disclosure of financial conflicts; pharmaceutical samples; individuals with financial conflicts participating in university purchasing decisions; financial support for educational events (on- and off-campus); industry support for scholarships and trainee funds; access of industry sales personnel to medical school or hospital personnel; and inclusion of education about conflict of interest within the academic curriculum. Additionally, the presence of oversight and sanctions is examined, but not included in grade calculation. 

 

Each year, every school is invited to submit new or updated policies for assessment. Institutions that do not submit policies are assumed to be unchanged from the prior year, and retain an unchanged assessment.  Schools that decline to participate after multiple attempts at follow-up receive a grade of F. Any institution submitting a formal notification that its policies are currently under review receives a grade of In Process (I), which may stand for up to one year. Institutions reviewing specific components of polices will retain their most recent grade with a note on current progress and their score evaluated upon implementation of the new policy. After a year of being In Process, if a school does not submit either policies for evaluation or a description of their progress in developing such policies, they receive a grade of F. 

 

Two blinded assessors independently score each set of policies in the eleven areas included in the scorecard. The letter grade is derived using a formula based on cumulative domain scores.  An institution may request an explanation or re-assessment of its score if policies change or if it feels it has been scored inappropriately by contacting scorecard@amsa.org. 

 

Next Steps and Assistance:

The Scorecard serves not only to measure the strength of policies, but also to provide a valuable resource for institutions to develop and refine new policies.  The inclusion of full text policies on the website (where permission has been given) facilitates this goal.

• To help medical students promote policy change, AMSA provides toolkits, templates, talks, and training institutes. These and other resources may be found at www.pharmfree.org.
• AMSA is proud to join forces with three other national organizations to create both external and internal pressure for medical schools and academic medical centers to adopt strong new conflict-of-interest policies, through a new initiative- the Partnership to Advance Conflict-Free Medical Education (PACME).
• Pew Charitable Trusts has worked with leaders within the profession, as well as policymakers, and has developed toolkits that include practical considerations and best-practice policies from leading academic medical centers.  Pew Charitable Trusts is a partner on PACME.
• The National Physicians Alliance (NPA) creates research and education programs that promote active engagement of physicians with their communities to achieve high quality, affordable health care for all.  Their Unbranded Doctor campaign provides resources for conflict-free medical practice.  NPA is a partner on PACME.
• Community Catalyst is a national non-profit advocacy organization working to build the consumer and community leadership that is required to transform the American health system.  Community Catalyst is a partner on PACME.
• Another resource is the Association of American Medical Colleges (AAMC) task force report on Industry Funding of Medical Education.

Suggested Citation: AMSA PharmFree Scorecard 2011-12. <<Title of Web Page>> (online), <<URL of Specific Web Page>>, Reston, VA:  American Medical Student Association <<Date Accessed>>.