Medical students left vulnerable by conflict of interest policies, say researchers

A group of Australian experts believe that university policies leave medical students vulnerable to commercial interests.

The researchers say that most university conflict of interest policies don’t address medicine-specific issues, like on-site sales representatives and pharmaceutical industry-funded education.

In a study published in the Internal Medicine Journal, the researchers review conflict of interest policies from 21 Australian medical schools.

“Strong conflict of interest policies are crucial to help protect students against industry influence in these formative years,” says senior author Professor Barbara Mintzes, a researcher at the University of Sydney.

“Financial relationships with industry can detrimentally influence medical education and clinical decision making, which include inappropriate prescribing and overdiagnosis.”

Of the 154 policies the researchers reviewed, only two were specific to medical schools – the rest were university-wide.

According to co-author Dr Travis Lines, a former member of the Australian Medical Students Association (AMSA) executive and now a physician at Alfred Health, university-wide policies may not be sufficient for medical students.

“In other areas of university life, a lot of the relationship between industry and university is about the way that they collaborate on research and the way that that research is used or commercialised,” says Lines.

“The way that healthcare stands out is that it actually goes to this healthcare decision that we make for our patients, as opposed to just research output.”

The researchers graded policies using a system developed by other researchers in a 2009 study.

They found little improvement since the 2009 study. Only one school received a ‘C’ grade, 17 schools received a ‘D’ and three received an ‘F’.

“There is research evidence from the US that doctors who attended medical schools with stronger conflict of interest policies restricting gifts and sales representatives prescribe more appropriately than those who studied at schools with weaker policies,” says lead author Ashleigh Hooimeyer, a PhD candidate at the University of Sydney.

Lines says that firmer policies come into place once students are practising as clinicians, particularly in hospitals, although there’s less regulation of private doctors.

“For most people who work in hospitals, there are rules around what kind of gifts you can expect in regard to your personal practice, which is pretty effective at governing the relationship that junior doctors have with industry,” says Lines.

But Lines believes this could be better extended to students as well.

“Part of the value of having really clear policies is not just the practical effect of the policy, it’s also what having those policies communicates to the student body – namely, that conflicts of interest are really important, and that as medical students and future doctors, we should be thinking about our obligation to our patients to do the best by them,” he says.

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The researchers were first spurred to do this study by members of AMSA, who had just updated their own policy.

“There is emerging and established evidence that medical students exposed to direct-to-clinician advertising during their studies may develop a more positive attitude towards the product or service advertised, raising ethical concerns,” says a spokesperson for AMSA.

“Standardising policy to prevent the unethical exposure of pharmaceutical companies during medical school would ensure that future doctors have well rounded and evidence-based knowledge to guide their prescribing.

“Additionally, we encourage the inclusion of comprehensive education regarding conflict of interest within the curricula, exploring topics such as the impact of pharmaceuticals and medical device marketing on prescribing, skills teaching regarding critical appraisal and sourcing of independent evidence as well as the ethical implications of interactions with pharmaceutical and device industries.”