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Conflict of Interest in Medical Research, Education, and Practice
initiated restrictions some years before the AAMC statement. Schools that ban vendor-provided meals on campus (e.g., Stanford University) may not be explicit about the acceptance of meals at off-site locations, although several schools (e.g., Yale University) also discourage this.
As discussed in more detail in Chapter 6, AMA allows gifts of modest value that are viewed as having some benefit to patients (e.g., meals as part of an educational activity) or the physician’s practice (e.g., notepads). The policies of several medical centers (e.g., Wake Forest University, Case Western Reserve University, and the University of Minnesota) are similar to this policy.
In addition to policy changes within the academic community, the Pharmaceutical Research and Manufacturers of America (PhRMA) recently revised its voluntary Code on Interactions with Healthcare Professionals (PhRMA2008, effective 2009). Except for the section on scholarships and education funds, the document does not refer specifically to interactions in academic settings. As discussed further in Chapter 6, the revised code more strongly discourages “noninformational” physician-company relationships, such as the provision of tickets to sporting events, token consulting arrangements, speaker training programs at resorts, and meals by sales representatives outside a physician’s office or other medical setting.
Industry-Sponsored Scholarships and Training Positions
Little information on the extent of industry funding for undergraduate and graduate medical education is available, although AAMC has stated that medical schools have become increasingly dependent on such funding for such major activities. The committee is aware of industry-funded residencies or fellowships in a few areas, for example, dermatology residencies funded by companies making dermatologic products (Kuehn, 2005); industry-funded fellowships in rheumatology (Goldblum and Franzblau, 2006); and industry support for psychiatry resident fellowships, awards, and the Chief Resident Leadership Conference (APA, 2008).
The rationale for industry funding of residencies and fellowships seems to rest on physician or researcher shortages in certain specialties and the desire to attract more individuals to these areas through additional industry-supported training positions. For example, the American Academy of Dermatology (AAD) launched an initiative in 2004 to fund 10 dermatology residency positions (Kuehn, 2005). The AAD created a fund to accept donations from the academy, pharmaceutical companies, and other interested parties. Awards were assigned to 10 university programs ($60,000