Changes in U.S. medical school conflict of interest policies from 2014 to 2023

Abstract

Background: Concerns about the influence of the pharmaceutical industry on medical education, ranging from education of students to professional development, have led professional societies to recommend regulation of interactions between industry and medical schools. The objective of this study was to evaluate conflict of interest (COI) policies at medical schools in 2023 compared to 2014.

Methods: This study used a cross-sectional design to evaluate the COI policies at the top 30 medical schools identified by US News and World Report rankings. The authors collected policies by survey and review of public websites, and assessed their quality across 15 domains informed by guidelines published by leading national organizations and previous PharmFree Scorecards. Each domain was graded on a 3-level scale derived from professional organization guidelines, which when totaled corresponded to the following letter grades: an "A" (score 38-45), "B" (32-37), "C" (25-31), and "I/F" (< 25). This study assessed industry payments to school leadership using the 2023 Open Payments database.

Results: Eleven of thirty medical schools submitted COI policies, and the remainder were analyzed based on publicly available information. No school received an "A," 22 (73.3%) schools received a "B", 6 (20.0%) schools received a "C", and 2 (6.7%) schools received an "I/F". Most schools had model policies around COI enforcement (29/30, 96.7%), gift acceptance (25/30, 83.3%), and ghostwriting (24/30, 80.0%). No schools had model policies in limiting direct faculty payments. When comparing 2014 and 2023 Scorecards over the shared 14 domains, 14 (46.7%) schools had a decrease in score, 11 (36.7%) schools had an increase, and 5 (16.7%) schools had no change. Faculty at every school accepted industry payments, including 20 (16.7%) deans and 52 (19.3%) of clerkship directors.

Conclusions: Medical school COI policies remain less stringent than consensus recommendations; thus, renewed attention to policies and implementation is needed to ensure bias-free medical education.

Fig 1. Numerical Scores for all Evaluated Schools, 2023.

Total scores were calculated for all included institutions. The maximum possible score is 45. We scored each of the 15 domains from 0-3, where 0 was assigned for missing policies, 1 for inadequate policies, 2 for moderate policies, and 3 for model policies. Schools colored in light grey received a “B”, schools colored in dark grey received a “C”, and schools colored in black received a “I/F”.

Fig 2. AMSA Scores Assigned by Domain, 2023.

The number of schools that have inadequate policies that do not address the domain (black, scored 1 point), moderate policies that are making progress towards model policies (gray, scored 2 points), or model (white, black outline) policies within each of the evaluated domains.

Fig 3. Median and Interquartile Range for Medical School Leadership Receiving Industry Payments, 2023. Box plots for medical school leadership receiving industry payments across all 30 medical schools, divided by dean of medical school (dark gray), other deans (light gray), and clerkship directors (white). A detailed breakdown of the “Other Deans” and “Clerkship Directors” categories is available in the supplemental material.

Fig 4. Changes in Frequency of Model Conflict of Interest (COI) Policies in 2014 and 2023.

A comparison of the 30 schools’ conflict of interest policies to model policies across the 14 consistent domains evaluated by this study in 2014 (gray) and 2023 (black).

Fig 5. Percentage of Medical School Leadership Receiving Industry Payments, 2023. The percentage of total evaluated individuals across all 30 medical schools who received industry funding, divided by the dean of medical school (black), other deans (light grey), and clerkship directors (dark grey).