title: Managing conflicts of interest in clinical care: the "race to the middle" at U.S. medical schools.
abstract: OBJECTIVE
  National recommendations specify how medical schools should manage clinical conflicts of interest (CCOIs), including gifts and payments to physicians from pharmaceutical companies. A 2008 study showed that few schools had policies in keeping with the recommendations. The authors conducted a follow-up study in 2011 to assess possible improvements.
  
  
  METHODS
  To obtain policies in 12 areas of CCOI, the authors searched the Web sites of all 133 medical schools existing in July 2011 and contacted schools that had no online policies. Policies were scored as no policy, permissive, moderate, or stringent, based on published recommendations; each school's scores were averaged to assess overall policy strength. Changes since 2008 were evaluated. The authors also collected information on schools' public/private status, hospital ownership/affiliation, and National Institutes of Health (NIH) funding to determine whether these characteristics were associated with differences in policy strength.
  
  
  RESULTS
  Policies were obtained for a representative sample of 127 (95%) medical schools. The frequency of stringent policies increased from 2008 to 2011 in all CCOI areas, and medical schools' overall policy strength more than doubled. However, less than stringent policies remained the norm for all areas except ghostwriting. Greater NIH funding was associated with stronger policies in five areas and with higher overall policy strength.
  
  
  CONCLUSIONS
  Schools have made great progress toward national standards, yet room for improvement remains: The data reveal not a race to the top but a shift from the bottom to the middle. Follow-up research should explore whether stronger policies emerge in the future.
authors: Dr. Chimonas is research scholar, Center on Medicine as a Profession, Columbia University, New York, New York. Ms. Evarts is research associate, Center on Medicine as a Profession, Columbia University, New York, New York. Ms. Littlehale is research associate, Center on Medicine as a Profession, Columbia University, New York, New York. Dr. Rothman is professor, Center on Medicine as a Profession, Columbia University, New York, New York.
authors: Susan
authors: S
authors: Chimonas
authors: Susanna D
authors: SD
authors: Evarts
authors: Sarah K
authors: SK
authors: Littlehale
authors: David J
authors: DJ
authors: Rothman
mesh_terms: D001319:Authorship / Q000592:standards; D016265:Conflict of Interest; D004345:Drug Industry; D037921:Gift Giving; D006801:Humans; D007400:Interprofessional Relations; D009316:National Institutes of Health (U.S.); D016134:Organizational Policy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012106:Research / Q000191:economics / Q000592:standards; D012109:Research Support as Topic; D012577:Schools, Medical; D014481:United States