Managing Conflicts of Interest in Clinical Care: A National Survey of Policies at U.S. Medical Schools

Chimonas, Susan PhD; Patterson, Lisa MSc; Raveis, Victoria H. PhD; Rothman, David J. PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e3182087156
Institutional Issues

Purpose: Policy recommendations specify how academic medical centers should manage clinical conflicts of interest (CCOIs), including gifts and payments to physicians from pharmaceutical companies. However, no reliable data exist on the extent to which schools have policies to manage CCOIs. The authors sought to determine the extent and strength of medical schools' CCOI policies.

Method: A survey asked compliance officers at 125 MD-granting medical schools in the United States to indicate whether their institutions had policies covering 11 areas of CCOI and to provide copies of relevant policies. Policies were scored as 0 (no policy), 1 (permissive), 2 (moderate), or 3 (stringent), based on published recommendations. Each school's scores were averaged to create a measure of overall policy strength. The authors also collected information on schools' public/private status, hospital ownership/affiliation, and NIH funding to determine whether these characteristics were associated with differences in policy strength.

Results: A representative sample of 77 of 125 (62%) medical schools responded between October 2007 and December 2008. Absence of policy was the most frequent finding in 7 of 11 CCOI areas. The mean score for overall policy strength was 1.2. Greater NIH funding was associated with stronger policies in 9 areas.

Conclusions: This analysis provides a comprehensive overview of medical schools' CCOI policies. Wider adoption of CCOI policies is crucial to eliminate undue industry influence in clinical care and to preserve public trust in the medical profession. The authors close with a consideration of why so few medical schools have implemented strong policies.

Author Information

Dr. Chimonas is associate research scholar, Center on Medicine as a Profession, Columbia University, New York, New York.

Ms. Patterson is research associate, Center on Medicine as a Profession, Columbia University, New York, New York.

Dr. Raveis is research professor, School of Dentistry, New York University, New York, New York.

Dr. Rothman is professor of social medicine, Center on Medicine as a Profession, Columbia University, New York, New York.

Correspondence should be addressed to Dr. Chimonas, Center on Medicine as a Profession, 630 West 168th Street, P&S Box 11, New York, NY 10032; telephone: (212) 305-6914; e-mail:

First published online January 18, 2011

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© 2011 Association of American Medical Colleges