Rising costs in healthcare and medical education, along with increased collaboration between public and private healthcare sectors after COVID-19, highlight the need to evaluate the relationship between U.S. medical institutions and the pharmaceutical industry. Pharmaceutical industry payments may influence prescribing behavior, including increased use of opioids and promoted medications. Such correlations may begin early in medical training and can affect patient trust.
These concerns are addressed by organizations such as the National Academy of Medicine and American Association of Medical Colleges (AAMC) that promoted the polices related to the conflict of interest (COI). A recent study in PLoS One aimed to assess these policies across medical institutions and also examined financial correlations, including medical school leadership, by using available payment information.
In this cross-sectional study, a total of 30 top-ranked US medical schools were included. These schools were listed by the 2022 U.S. News & World Report. COI polices were evaluated across 15 domains, including a new category on direct industry payments through the Centers for Medicare & Medicaid Services data, and compared with 2014 benchmarks from the American Medical Student Association (AMSA) score card.
All the necessary data were collected by using surveys, which were sent to the academic leaders and supplemented with publicly available policies. Payments to institutional leadership were analyzed through 2023 open payment data, with ≥$5,000 considered as a significant payment. Descriptive analysis and t-tests were performed to compare the 2014 scores data with the 2023 data.
Among 30 medical schools, around 36.7% (n = 11) submitted updated COI polices during 2023, whereas the remaining schools were obtained publicly. No school achieved an “A” grade, 73.3% (n = 22) received “B”, 20% (n = 6) received “C”, and as well as and 6.7% (n = 2) received “I/F.” mean scores did not differ significantly between submitting and non-submitting medical schools (34.3 vs 32.2) with p = 0.11. Strongest domains included promotional speaking (70%), gift bans (83.3%), enforcement (96.7%), and ghost-writing (80%). However, no schools had model conflict-of-interest (COI) policies addressing industry payments for CME support or for their faculty members.
All medical schools reported industry payments to leadership. Median payments to deans reached $165,002.22 (IQR: $272-$193.28), and 70% (n = 21) of medical schools exceeded the cost of $5,000 in total payments. Among 120 deans, approximately 16.7% received payments, whereas among 270 clerkship directors, 19.3% received payments.
Comparing 2014-2023, 16.7% remained unchanged, 36.7% of schools improved, and 46.7% declined. The mean scores showed no statistical significance difference (32.7 [2014] vs 31.7 [2023]) with p = 0.14. Although 64.3% of domains declined, with a significant drop in COI policies on industry-sponsored events (2.1 vs 1.8), with p = 0.02.
Fewer schools achieved model COI policies across domains, with declines in curricula (9 schools [2014] to one school [2023]), consulting (7 to 1 school), and events (8 to 2 schools). Policies often lacked strict bans, and most schools had vague or insufficiently detailed COI curricula.
In conclusion, the 2023 AMSA scorecard highlights opportunities to strengthen COI policies aimed at improving patient care, promoting unbiased medical education, and supporting evidence-based prescribing, while emphasizing the need to monitor ongoing institutional policy changes.
Reference: Bhat S, Shenoy DA, Wojtara M, et al. Changes in US medical school conflict of interest policies from 2014 to 2023. PLoS One. 2026;21(3):e0344046. doi:10.1371/journal.pone.0344046
