Executive Summary  Updated June 16, 2009

This document reflects school results 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

The AMSA PharmFree Scorecard evaluates conflict-of-interest policies at 149 medical colleges and colleges of osteopathic medicine in the United States, with a focus on 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 current and changing landscape of conflict-of-interest policies across American medical education, as well as more in-depth assessment of individual policies that govern industry interaction.

The Scorecard examines potential conflicts of interest created by industry marketing at the level of the individual physician and trainee. The Association of American Medical Colleges, which recently proposed strong guidelines for many of these domains, has also addressed institutional and research conflicts of interest in earlier reports.

For an archive of the 2008 policy assessments, click here.

To display assessments from 2008, click and hold anywhere on this map.

Methods

The PharmFree Scorecard methodology was developed jointly by AMSA and the Pew Prescription Project.  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 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.  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 (see methodology). An institution may request an explanation or re-assessment of its score if policies change or if it feels it has been scored inappropriately.

 

Summary of results

Of 149 US medical schools, 9 receive As (6%), 36 Bs (24%), 18 Cs (12%), and 17 Ds (11%).

35 schools (23%) receive a grade of F. This includes 12 that either submitted policies graded as F or indicated they had no relevant policies, as well as 8 schools that declined to participate and 10 that did not respond to repeated attempts at follow-up both in 2008 and 2009. An additional 5 schools received Fs when 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 a school that has not submitted policies may 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.

As of June 16, 2009, 131 of 149 medical institutions have participated in the Scorecard, an 88% participation rate. (Non- participants include 8 schools that declined participate and 10 that have not yet responded.)

There are fewer I grades in 2009, compared with 2008. 27 institutions (18%) received a grade of In Process because they indicated that they are currently revising or creating new policies, compared with 43 in 2008. While 22 of last year’s In Process schools subsequently submitted new, and often strong policies, 5 failed to submit new policies and therefore received a grade of F. Of the 27 In Process schools, 15 have extended their 2008 In Process designation, and 12 are newly In Process.

An additional 7 schools have been given an In Process designation for pending assessments. These submissions, received late, will be assessed within 60 days of the 2009 launch date.

Trends by domain

Between 2008 and 2009, the number of perfect scores increased in almost every domain. As in 2008, 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. Almost twice as many schools received perfect scores in these domains in 2009, compared with 2008. The areas with fewest perfect scores were on-campus continuing medical education and the access of sales representatives (for which only one AMC received a perfect score).

The following is a list of domains and the number of perfect scores in each:

Scholarships – 66
Off-campus continuing medical education –  49
Purchasing – 47
Gifts – 44
Curriculum – 28
Consulting – 27
Samples – 20
Speaking – 10
Disclosure – 5
On-campus continuing medical education – 2
Sales representatives – 1

Trends and analysis

Over one-fifth of U.S. medical schools (21%) improved their conflict-of-interest policies in the past year (including movement from In Process to an A, B, or C.)

45 institutions, close to one-third, now have grades of A or B. This is a substantial increase over 29 A and B schools (19%) in 2008.  Approximately 30 percent of medical students in the U.S. are now studying at an A or B school.

Medical schools in Maryland fared extremely well in 2009. Johns Hopkins School of Medicine received an A, while University of Maryland School of Medicine and Uniformed Services University of the Health Sciences received Bs. Other schools in the Potomac region, including Washington, DC, and Virginia did less well, with 2 Fs, 2 In Processes, 2 Ds and 1 C.

The state of California continued to excel; 3 medical schools in the University of California system received As, reflecting system-wide adoption of strong policies in certain domains (modeled after those first introduced at UC Davis). Two UC schools and Stanford School of Medicine received Bs. Loma Linda University Adventist Health Sciences Center and Western University of Health Sciences College of Osteopathic Medicine received Fs.  Other results in California included one C, and one I.

One half of Texas's 8 medical schools now receive an A or B, compared to just two in 2008. They are University of Texas Medical Branch at Galveston (A), University of Texas Southwestern Medical School (B), Baylor College of Medicine (B), and University of Texas Health Science Center at San Antonio (B). The four remaining medical schools in Texas received a D, an F and 2 Is.

A majority of medical schools in Massachusetts were given strong grades on the Scorecard.  Harvard, the University of Massachusetts Medical School, and Boston University received Bs.  Tufts University School of Medicine received a D.

New York State, another hub of medical care and education, had mixed results.  Mount Sinai School of Medicine, one of the highest scoring institutions, received an A.  Columbia College of Physicians and Surgeons, SUNY Upstate, and New York University School of Medicine were given Bs.  However the remaining 10 New York schools received two Cs, three Ds, four Fs and one I.

The cluster of Illinois medical schools, some of national renown, improved this year over their 2008 scores. Stritch School of Medicine at Loyola received a B, as did University of Chicago Pritzker School of Medicine and Rush Medical College. The University of Illinois College of Medicine at Chicago, whose policies cover the Rockford, Peoria, and Urbana-Champaign campuses, received a D.  Other grades included two Cs and one F.

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) will facilitate this goal.

To help medical students promote policy change, AMSA provides toolkits, templates, talks, and training institutes.  

The Prescription Project has worked with leaders within the profession, as well as policymakers, and offers toolkits that include practical considerations and best-practice policies from leading academic medical centers.

Another resource is the Association of American Medical Colleges (AAMC) task force report on Industry Funding of Medical Education.

These and other resources may be found at www.pharmfree.org.



Suggested Citation: AMSA PharmFree Scorecard 2009. <<Title of Web Page>> (online), <<URL of Specific Web Page>>, Reston, VA:  American Medical Student Association <<Date Accessed>>.