IMAP Shows How Academic Medical Centers (AMCs) Are Regulating Relationships With Drug And Device Makers

The Institute on Medicine as a Profession (IMAP) launched the first database of its kind to let the public, journalists, policymakers, compliance officers, and government officials see and compare conflict of interest (COI) policies among the nation's 125 academic medical centers. The IMAP AMC Conflict of Interest Policy Data Base will be a one-stop resource to help users identify what academic institutions are doing or not doing to limit the influence of drug and device makers on medical practice and will offer users a toolkit on how to implement strong policies.


The new site (imapny/coi_database) will feature policies in 12 key areas that AMCs are now looking at to regulate relationships with drug and device manufacturers: gifts; meals; drug representative access; samples; purchasing committees; continuing medical education; consulting and honoraria; scholarships and travel; ghostwriting; speakers' bureaus; enforcement; and implementation. The website is the result of a comprehensive effort to collect and analyze medical school policies. The site currently has 90 of 125 AMCs' policies and will be updated and expanded regularly.


IMAP, based at Columbia University's College of Physicians and Surgeons, conducted this project under the auspices of the Prescription Project, funded by the Pew Charitable Trusts. The website is also supported by a grant from the Attorney General Consumer and Prescriber Grant Program.


IMAP is launching the database amid a growing movement by AMCs to adopt COI policies. Last month, Stanford University was the latest institution to announce that it would restrict drug industry support of continuing medical education. An analysis in the September 3, 2008, Journal of the American Medical Association (JAMA) by IMAP President David Rothman and co-investigator Susan Chimonas shows that AMCs are increasingly adopting COI policies without any backlash from faculty or industry. Rothman and Chimonas reported that at least 25 AMCs have embraced strong COI policies to regulate industry relationships, and faculty are overwhelmingly supporting those efforts. The September 3 article "New Developments in Managing Physician-Industry Relationships," can be accessed at jamamedia.


"An astonishing amount of change has happened since 2006," says IMAP President Rothman, referring to the year when IMAP and the American Board of Internal Medicine Foundation issued a call to action to AMCs to adopt COI policies that also appeared in JAMA. Noting that the Pharmaceutical Research and Manufacturers Association in January 2009 will call on drug companies to ban the provision of gifts and meals in doctors' offices, Rothman notes that "even industry recognizes that this is the way the wind is blowing."


IMAP is not rating or ranking AMCs. However, the website does provide users with examples of "best practices" that feature model policies. Institutions that have adopted strong COI policies include the entire University of California system, the University of Pennsylvania, University of Pittsburgh, University of Massachusetts, University of Wisconsin, Boston University, Yale University, the University of Louisville Kentucky, and the University of Kansas.


Institutions that lack policies or have weak COI policies include Brown University, Penn State, Johns Hopkins University School of Medicine, Harvard University, Washington University in St. Louis, Drexel University, University of South Dakota, Tufts University, and West Virginia University. Other than Mt. Sinai School of Medicine, the other 12 medical schools in New York lack strong or effective COI policies. Columbia University is evaluating its current COI policies as they extend to potential conflicts related to clinical care and will soon have them in place.


All of the policies on IMAP's website will be available as downloadable PDFs. This database is geared to help AMCs strengthen their policies and provide technical assistance. The best practices toolkits on the site represent the "best thinking on what COI policies should look like and what your neighbors are doing," says IMAP's Chimonas.


The Institute on Medicine as a Profession seeks to shape a world inside and outside of medicine that is responsive to the ideals of professionalism. IMAP supports research on the past, present, and future roles of professionalism in guiding individual and collective behavior. It aims to make professionalism relevant to physicians, leaders of medical organizations, policy analysts, public officials, and consumers. To learn more about IMAP, visit imapny. For more information on the IMAP AMC Conflict of Interest Data Base, visit the site at imapny/coi_database.

Institute on Medicine as a Profession

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