The American Medical Student Association has a Scorecard ranking of American Medical School COI policies (AMSA PharmaFree), with an explicit focus on the involvement of the pharmaceutical sector. See the following story for a detailed discussion of this ranking: Medical Students, Pew Find Improvement in Medical School Pharmaceutical Conflict-of-Interest Policies, But Many Lag
Over one-fifth of U.S. medical schools improved their conflict-of-interest rules in the past year, yet dozens of others lag behind according to the 2009 American Medical Student Association (AMSA) PharmFree Scorecard, released today. The Scorecard, developed by AMSA and the Pew Prescription Project, finds that 45 of 149 medical schools now receive a grade of A or B for their policies governing pharmaceutical industry interaction with medical school faculty and students, compared with only 29 last year. However, for the second year, dozens of schools received grades of D or F and remain far behind the national leaders…
This type of detailed analysis and ranking goes a long way to helping map out the terrain of COI policies in institutions. It also provides the data necessary for researchers and policy makers to think about how to develop better governance mechanism. My one critique would be that in focusing almost exclusively on “Big Pharma” and financial relations with medical schools, critics and policy makers may ignore or downplay other non-financial interests, or relations with other actors that can still contribute to important COI.
Bryn Williams-Jones
In Canada, the leading research ethics policy is the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS), first implemented in 1998 and updated most recently in 2005. The policy is currently undergoing a major redrafting, involving cross country consultations on a 2nd Edition draft.
Of interest for this blog, are the changes being made to the part of the policy dealing with COI. In the current version of the TCPS, COI is dealt with rather briefly in Section 4, giving some attention to issues facing researchers, but very little regarding COI for institutions or research ethics boards. The new draft addresses COI in much more detail in Chapter 7, with clearer definitions of individual and institutional COI, examples and recommendations. This chapter still needs some polishing and clarification (the draft is open for revisions until the end of June), but I think constitutes a major improvement over the 1st edition of the TCPS.
Bryn Williams-Jones
The recent moves by the NIH to toughen up COI regulations have been met with much support, but also some critique, from policy makers and now academic groups. The following story — Drawing Lines on Conflicts of Interest – does a nice job of explaining some of the challenges of the NIH recommended reporting requirements, for both universities and the public service. Specifically, the Association of American Universities and the Association of American Medical Colleges, who have been active in promoting improvements to COI governance procedures in universities, query the extent to which detailed reporting to federal agencies of even low level financial interests is feasible, and useful in dealing with more important COI.
The good thing about such debate is that it gets both policy makers and the academic community thinking more clearly about what the actual dangers are with various forms of financial (or other) COIs, the thresholds at which interests become problematic, and the practical and effective mechanisms that can be implemented…
Bryn Williams-Jones
The University of Oregon is in the process of re-working its COI policy, which apparently is focused primarily on managing financial conflicts of interest; the University has taken the decision to separate this from discussions about conflict of commitment. The following story — Questions of conflict confront professors — does a nice job of working through some of the reasons for such a separation in a policy. I think three issues are worth noting:
1) dealing with financial COI related to research is a challenge, particularly with regards to determining what financial threshold actually constitutes an undue enducement or COI.
2) there are other non-financial interests that can bias judgements, research etc. and these should be addressed in a COI policy.
3) it is important to also think and talk openly about the diversity of roles that professors and researchers have (or should have) in an academic institution. How much time can a prof legitimately spend doing outside activities (and what are these?) that are or are not linked to their position as a prof? In many institutions, serving on outside committees, doing public outreach, etc. is a legitimate and even required part of one’s academic responsibility. So in order to see whether there is a conflict of commitment, its critical to have a clear sense of the types of activities, and the amount of time involved, that profs can and should engage in, and where their priorities should be.
Whether the issues of conflict of interest and conflict of commitment should be in separate policies is an open question, to my mind. They key is that such policies be written in a manner that is accessible and relevant to the broad university community, and is practial in helping faculty, administrative staff and other identify and manage conflicts.
Bryn Williams-Jones