interests can be carried too far, encouraging “readers to make ad hominem judgements” (Rothman, 2001, p. 1275) or shifting “attention away from the merits of the work and toward the biography of its author” (Jansen and Sulmasy, 2003, p. 40). Another critic describes disclosure policies as a kind of “new scientific McCarthyism” that assumes that researchers with industry ties are “tainted and untrustworthy” (Whelan, 2008, p. A19). One researcher has criticized “conflict of interest vigilantes” who “search for evidence that doctors have failed to disclose corporate connections in publications or in presentations” (Stossel, 2007, p. 59). He has also argued that continuing medical education disclosure policies mainly serve to protect bureaucrats rather than students, are based on ideology rather than evidence, and “are deeply disrespectful of physicians and researchers” (Stossel, 2008, p. 476). (See Chapter 1 for additional criticisms.)

Others, however, argue that conflict of interest policies—when they exist—are often weak, inconsistent, and inadequately administered and enforced. For example, the American Medical Student Association (AMSA) assessed the conflict of interest policies of medical schools and concluded that the policies of the majority of the schools that responded either lacked important elements or were unlikely to influence behavior (AMSA, 2008b).1 Whether or not one agrees with how AMSA rated the policies, the actual texts of the policies (available at or through the AMSA website) reveal considerable variability, which is consistent with the findings of this report. Members of the U.S. Congress have strongly criticized physicians and researchers who have failed to report substantial financial relationships with industry, as they were required to do, and have proposed that pharmaceutical and medical device companies be required to report publicly their payments to physicians (see, e.g., Grassley [2008b, 2009]). Also in response to concerns about the nature of financial ties between physicians and industry and the lack of disclosure of such ties, Massachusetts enacted legislation in 2008 that requires companies to report payments to physicians, researchers, and medical societies and further provides for a marketing code of conduct

1

In AMSA’s assessment, 9 medical schools received a rating of A and 19 received a rating of B for their policies; 44 schools received a rating of F (18 for the contents of the policies that they submitted, 9 for their refusal to submit policies, and 17 for their lack of a response after repeated requests). Another 46 schools had policies under revision. (The numbers of schools are based on the ratings listed as of February 13, 2009, at http://www.amsascorecard.org/.) The project’s methodology, included the rating system, is available at http://amsascorecard.org/methodology and states that “[e]ach policy was graded by two independent assessors, blinded to the institution of origin. Any differences in scoring between the two assessors were resolved by a consensus process. The assessors received formal training in the use of the scoring system, independently evaluating and coming to a consensus on five training policies before beginning to evaluate the medical school policies.”



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