Hopkins School of Medicine received an "A" grade on the American Medical Student Association (AMSA) PharmFree Scorecard this year, up from the "D" grade it received in 2008.
The scorecard, which reviews medical schools for the "presence or absence of a policy regulating the interactions between their students and faculty and the pharmaceutical and device industries," praises Hopkins for its "strong policies governing the relationships between its medical staff and the pharmaceutical industries".
According to the AMSA Web site, Hopkins exhibits exceptional behavior in many areas regarding the relationship between the medical school and drug companies.
Areas of the scorecard for which Hopkins displayed model behavior include the manner in which consulting relationships are conducted and reported, the practice of refusing free pharmaceutical samples and the recusal of individuals with financial interests from relevant purchasing decisions.
The new assessment is a result of a tougher stance taken by the Hopkins School of Medicine on its relations with the pharmaceutical industry.
The new Johns Hopkins Medicine (JHM) Policy on Interaction with Industry took effect this summer and created a rigid set of guidelines on dealing with drug companies.
These guidelines sought to reduce actions that create conflicts of interest among physicians involved in relations with private businesses.
The policy's major components are its prohibition of physicians accepting gifts from pharmaceutical representatives and its restrictions on dealings between physicians and industry.
"There has been a great deal of discussion among leaders of academic medical centers about these concerns, and some data have been published demonstrating that even small gifts and other considerations from industry can influence, consciously or unconsciously, how one makes decisions," Julie Gottlieb, the assistant dean of the Johns Hopkins Medical School and Policy Coordinator, wrote in a e-mail to the News-Letter.
Many doctors at Hopkins are supportive of these policies.
"I think the majority of physicians at Hopkins probably support the general direction of the policy, and they are working hard to abide by it," Gottlieb wrote.
As thorough as Hopkins's new policies are, the AMSA suggests that more improvements can be made to further limit conflicts of interest.
The AMSA Web site states that Hopkins's policy of disclosure of activities among physicians and the pharmaceutical companies do not apply to all staff members and hints that Hopkins should increase its disclosure.
"Because there is no requirement for all staff to file periodic disclosures on external relationships/potential conflicts broadly, a 1 (low score) must be given for this domain," the AMSA scorecard states.
However, according to Gottlieb, the term "disclosure" is the subject of some confusion because various institutions use it to mean different things.
Disclosure can refer to reporting outside relationship and financial interests to either one's employer, or to various internal and external audiences such as students, and at conferences.
The Hopkins policy requires that faculty disclose their financial interests both internally for review under conflict of interest policies, and if there is potential for conflict of interest in research.
In addition, if financial interests are allowed to exist with research, researchers are required to disclose the interest externally in all publications and presentations.
According to Gottlieb, the AMSA explanation for a low score under disclosure is inaccurate based on these policy components.
"I think the new policy is an important step in the direction of limiting certain types of drug and medical device company activity - those motivated primarily by marketing - at Johns Hopkins Medicine. With time, we will be able to tell to what extent the policy - and similar policies at other medical centers - has succeeded and what steps need to be taken to reach our goals," Gottlieb wrote.
While Gottlieb praised the AMSA PharmFree Scorecard for its mission of creating awareness on the unethical relationships between medical schools and industries, she commented that their assessments are not always accurate.
Confusion in terminology such as disclosure creates discrepancies in their grading, and according to Gottlieb, they neglected some of the new requirements included in the JHM policy.
However, she acknowledged the importance in educating physicians in the impact of market-driven support.
"Companies will always market their products," Gottlieb wrote, "but hopefully current students and trainees will enter practice using their professional judgment and evidence-based medicine."
In response to the discussion of how to most effectively disclose faculty and physicians' interests, a bill is pending in Congress which would require all pharmaceutical and medical device companies to report payments to physicians on a public Web site.
In response to this so-called Sunshine Act, a few large companies have started posting payments online.
