- Many groups consider the participation of academic clinicians on industry-sponsored speakers' bureaus to be problematic conflicts of interest.
- Despite this, only 38% of medical schools bar their faculty from participating, and many school's policies leave wiggle room.
- About a decade ago, nearly half of medical schools prohibited faculty participation, indicating that policies have become less strict.
Just a little more than a third of medical schools forbid faculty from participating in industry-sponsored speakers' bureaus, a cross-sectional analysis found.
Out of 129 conflict-of-interest policies obtained from allopathic medical schools in the U.S., only 49 (38%) explicitly prohibited faculty involvement in these speakers' bureaus, reported Jonathan Alpern, MD, associate professor of medicine at the University of Minnesota in Minneapolis, and colleagues.
Additionally, 25 (19%) prohibited speakers' bureau participation with exceptions or allowed them with conditions, 11 (9%) \discouraged participation without conditions, 17 (13%) permitted participation, and 27 (21%) did not have policies on these groups, authors wrote in JAMA Network Open.
"That the majority of schools don't outright ban faculty from participating in industry-sponsored speakers' bureaus was surprising considering the increased attention and scrutiny of this practice in recent years," Alpern told MedPage Today, also noting that the language used in these policies varied and left room for interpretation.
Pharmaceutical companies frequently recruit and compensate influential physicians to give presentations about company products. But in speakers' bureaus, faculty operate as paid spokespeople, thus "relinquishing substantial control of the educational content to the pharmaceutical company," authors wrote.
These relationships have been criticized as potential conflicts of interest, and some groups, like the Institute of Medicine and the American Medical Student Association (AMSA), have recommended that medical education institutions bar faculty from participating in industry-controlled educational presentations.
A 2014 analysis found that about half of U.S. medical schools effectively banned faculty from speakers' bureaus. Because that percentage has dropped since then, authors said it "suggests that medical schools' [speaker's bureau] policies have become less strict over the past decade."
Moreover, in November 2020, the U.S. Office of Inspector General issued a special fraud alert of cases that alleged that significant speaker payments were being paid to high-prescribing physicians on speakers' bureaus, which violates the kickback statute.
"Although many schools are clearly trying to discourage faculty from engaging with the pharmaceutical industry in this way, by stopping short of explicitly prohibiting this practice, it may give faculty enough wiggle room to justify these relationships," Alpern said, adding that the study shows that more work is needed.
Ultimately, authors argued for a total ban on speakers' bureau participation among academic medicine physicians.
"To ensure that faculty and clinical practice remain independent from industry influence, U.S. medical schools should adopt the best practice of explicitly prohibiting faculty from participating in [speakers' bureaus]," the authors concluded.
In an accompanying editorial, Jennifer Miller, PhD, of the Yale School of Medicine in New Haven, Connecticut, and Christopher Robertson, JD, PhD, of Boston University School of Law, argue that solving the problem of industry's influence on medical education is more complicated, though they agree that speakers' bureaus could compromise the best interests of the patient by creating a financial relationship between clinicians and industry.
"[E]ven if banned by universities, industry likely would redirect funding to other channels of influence, a phenomenon akin to placing a finger in a stream only to see the water flow around it," they wrote. "The question is not just whether faculty should participate but how the medical profession will step up to provide more transparent, credible, and ethically sound alternatives."
Miller and Robertson also recognized that spreading knowledge about new medical products is a good thing, and it makes sense that companies lead the charge in disseminating information about their products.
For a potential alternative model of medical product education, they point to continuing legal education, which "uses employer subsidies, rather than industry sponsorship, to reduce financial [conflict of interests] and enhance integrity."
For their study, Alpern and team collected 129 conflict-of-interest policies about speakers' bureaus from 159 U.S. allopathic medical schools (81%) through their websites or emails. These policies were coded as explicitly prohibited, prohibited with exceptions or allowed with conditions, discouraged without conditions, explicitly allowed, or not addressed. Each policy was independently coded by two authors, with 92% agreement. For the remaining 10 in which there was disagreement, two additional authors resolved eight with unanimous agreement. The final two were decided with team consensus.
Authors only analyzed allopathic medical schools, which they noted as a limitation. Plus, policies were subject to interpretation which could have led to misclassification.
They suggest that future research assess the impact of conflict of interest policies on faculty behavior. Alpern noted their team is planning to assess faculty compliance with ISSB policies.
Disclosures
This study was funded by Arnold Ventures and used resources and facilities at the Minneapolis VA Healthcare System.
No study authors had conflicts of interest.
Miller reported receiving fees from CSL, being a board member for Bioethics International, being an advisor for CSL and Galatea Bio, and receiving grants from FDA, Flatiron Health, Yale and the World Partnership Fund, Bioethics International, and Bristol Myers Squibb.
Robertson had no disclosures.
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