# Changes in U.S. medical school conflict of interest policies from 2014 to 2023

## TL;DR

This study compares conflict of interest policies at top U.S. medical schools in 2023 to those in 2014, finding that most policies still fall short of recommended standards.

## Contribution

The study evaluates and compares COI policies across 30 top U.S. medical schools using a standardized scoring system from 2014 to 2023.

## Key findings

- Most schools had strong policies on enforcement, gift acceptance, and ghostwriting, but none had model policies for limiting direct faculty payments.
- Over half of the schools saw a decrease in COI policy scores from 2014 to 2023.
- Faculty at all schools accepted industry payments, including many deans and clerkship directors.

## Abstract

Concerns about the influence of the pharmaceutical industry on medical education, ranging from education of students to professional development, have led professional societies to recommend regulation of interactions between industry and medical schools. The objective of this study was to evaluate conflict of interest (COI) policies at medical schools in 2023 compared to 2014.

This study used a cross-sectional design to evaluate the COI policies at the top 30 medical schools identified by US News and World Report rankings. The authors collected policies by survey and review of public websites, and assessed their quality across 15 domains informed by guidelines published by leading national organizations and previous PharmFree Scorecards. Each domain was graded on a 3-level scale derived from professional organization guidelines, which when totaled corresponded to the following letter grades: an “A” (score 38–45), “B” (32–37), “C” (25–31), and “I/F” (< 25). This study assessed industry payments to school leadership using the 2023 Open Payments database.

Eleven of thirty medical schools submitted COI policies, and the remainder were analyzed based on publicly available information. No school received an “A,” 22 (73.3%) schools received a “B”, 6 (20.0%) schools received a “C”, and 2 (6.7%) schools received an “I/F”. Most schools had model policies around COI enforcement (29/30, 96.7%), gift acceptance (25/30, 83.3%), and ghostwriting (24/30, 80.0%). No schools had model policies in limiting direct faculty payments. When comparing 2014 and 2023 Scorecards over the shared 14 domains, 14 (46.7%) schools had a decrease in score, 11 (36.7%) schools had an increase, and 5 (16.7%) schools had no change. Faculty at every school accepted industry payments, including 20 (16.7%) deans and 52 (19.3%) of clerkship directors.

Medical school COI policies remain less stringent than consensus recommendations; thus, renewed attention to policies and implementation is needed to ensure bias-free medical education.