branden pfefferkorn , md may 8, 2009 mph spring symposium
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Comparing policies on health industry conflicts of interest at academic medical centers: peer pressure’s positive power. Branden Pfefferkorn , MD May 8, 2009 MPH Spring Symposium. Acknowledgements. Committee members: Sarah Davis, JD, MPA Lee Vermeulen, MS, RPh Mark Wegner, MD, MPH - PowerPoint PPT PresentationTRANSCRIPT
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Comparing policies on health Comparing policies on health industry conflicts of interest at industry conflicts of interest at academic medical centers: academic medical centers: peer pressure’s positive peer pressure’s positive powerpower
Branden Pfefferkorn, MDMay 8, 2009MPH Spring Symposium
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AcknowledgementsAcknowledgementsCommittee members:
◦ Sarah Davis, JD, MPA◦ Lee Vermeulen, MS, RPh◦ Mark Wegner, MD, MPH
The Pew Prescription Project/Pew Charitable Trusts◦ Gabrielle Cosel◦ Allan Coukell, BSc.◦ Two intern reviewers
Center for Patient Partnerships◦ Meg Gaines, JD, LLM and Aphra Mednick, MSW, LCSW
Gabriel Silverman, 2008 Scorecard DirectorAMSA leaders: Rebecca Sadun, Nitin Roper, Jack
RusleyPat Remington, MD, MPH and Barb Duerst, RN, MSEllen Selkie, MD, Analisa Calderón, family and
friends
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OverviewOverviewBackgroundIntroduction to the PharmFree
ScorecardProject ObjectivesScorecard MethodologyResultsDiscussionConclusions
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BackgroundBackgroundHealth industry marketing influences
medical education and, by extension, prescribing behaviors
Industry relationships in academic medical centers are common
Bias is not just a result of individual behaviors or attitudes
Perceptions of industry influence may affect patient adherence to treatment recommendations
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The PharmFree ScorecardThe PharmFree Scorecard
The American Medical Student Association ranked all US medical schools on their conflict of interest policies
The 2008 version provided a rigorous methodology
The scorecard will be updated annually to allow schools to revise the evaluation
When given permission, the school’s policy is uploaded to the scorecard website
Resources are made available to schools for developing policy
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Project ObjectivesProject ObjectivesUpdate the Scorecard for 2009Increase both external and
internal awareness (communicate with press)
Begin to assess policy implementation, monitoring, and adherence
Transition leadership to 2010 director
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Scorecard Methodology-Scorecard Methodology-Policy AssessmentPolicy Assessment
Two blinded reviewers assess policies using the scoring instrument
Evaluated domains:◦ 1. Individual gifts◦ 2. Pharmaceutical Samples◦ 3. Purchasing & Formularies◦ 4. Industry Sales Representatives◦ 5. Education◦ 6. Enforcement (not scored)
0-3 score in each domain
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Making the gradeMaking the gradeScores of best three sub-domains
are averagedA ≥ 85%
B ≥ 70%C ≥ 60%D ≥ 40%F < 40% I = In Process
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ResultsResults2008: 115 of 151 schools
participated (76%)13% had A’s or B’s, around 25%
were “in process”Due to the Scorecard, medical
schools receive feedback from:◦ Popular press articles◦ Applicants◦ Administrators◦ Current students
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Press CoveragePress Coverage
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Discussion: Inducing Discussion: Inducing organizational organizational isomorphismisomorphismDiMaggio & Powell 1983
◦ Isomorphism is “the resemblance of a focal organization to other organizations in its environment”
◦ Organizational legitimacy is conferred by regulatory endorsement and public endorsement
◦ Explosion of popular press, numerous professional organizations moving toward limiting influence (AAMC, APA, IOM), and Congress and the NIH have been involved
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Discussion: LimitationsPotentially valuable collaborative
relationships between industry and academic medical centers are lost
The costs and harms of implementing policies should be evaluated
The effectiveness of policies in reducing identified conflicts of interest is also an important avenue for further research (cautionary tale provided by disclosure policies)
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Other Public Health Other Public Health ImplicationsImplications
Use of a scorecard model ◦ University technology transfer & access to
technologiesThe trouble with isomorphism
◦ Early adopters lose legitimacy if their position is not broadly adopted (e.g. Madison smoking ban)
Other uses of organizational isomorphism:◦ Green businesses◦ Reducing health disparities?
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ConclusionsConclusions
The PharmFree Scorecard establishes a standard for effective conflict of interest policies at academic medical centers
Academic medical centers face multiple pressures to implement more stringent policies
Inducing institutional change has other public health applications
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Thank you!Questions?Branden Pfefferkorn
www.amsascorecard.orgMonday, June 8: Scorecard 2009 release
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PerspectiveA vicious cycle is created by a mad scramble for a share of the market: the doctor is made to feel he needs more “education” because of the prolific outpouring of strange brands but not really new drugs, produced for profit rather than to fill an essential purpose; and then the promoter offers to rescue him from confusion by a corresponding brand of “education.”
Charles D. May, editor of Pediatrics1961
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Scorecard TimelineScorecard Timeline
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Scorecard recognition“Particular incentives can have both positive
and negative aspects. For example, when it rated medical schools on their conflict of interest policies, the American Medical Student Association used the “sunshine” of publicity in ways that were positive for schools that it viewed as having good policies and possibly embarrassing for the schools that it viewed as having deficient policies.”
Institute of Medicine Report, 4/28/2009