conflicts of interest, such as institutional stakes in start-up companies that seek to sponsor research at the institution.

Although the 2008 AAMC-AAU report did not explicitly recommend governing board responsibility for policies on institutional conflicts of interest, their report can still provide useful guidance to NIH and to grantee institutions and a model for developing case studies to provide education on the evaluation of conflicts of interest. Because experience with and evaluations of institutional conflict of interest policies are limited, the investigation of such policies should be one focus of the research agenda recommended in Chapter 9. In addition, continued attention to this area—for example, further surveys of policy adoption—by AAMC would also be constructive.

The intent of the recommendations in this report is to promote a culture in which conflicts of interest are taken seriously by institutions and individuals engaged in medical research, education, and practice and practice guideline development. For this to happen, institutions must effectively manage their own conflicts and be seen to be doing so. The board and the senior officials set the tone for the institution. They should be accountable for making sure that their own institutional interests are in order.