Making Change: Some findings on dynamics of change
This curriculum is part of an action oriented program to facilitate change by outlining the dynamics of institutional and behavior change and by identifying and mobilizing change agents. Some findings on how change occurs and who is instrumental in bringing it about:
• Change comes from the top down
• Deans are key players in leading change
• Pharmacy and Therapeutics (P&T) Committees and particularly Chairs are important supporters
• Faculty leadership must endorse new policies
• Consensus building and debate is important to the process
• No noticeable faculty flight; in fact, support for more stringent policies is usually strong
• Some compromise is necessary
• No reported decrease in pharmaceutical company funding for research
• No complaints about disappearance of free stuff (stationery etc.) or even meals
Why are AMCs important?
“Academic medical centers, which include medical schools and their affiliated hospitals, should provide leadership for medicine in the United States. Just as pharmaceutical manufacturers look to AMCs for influential advice and support, so does the medical profession. Academic medical centers also have a major responsibility for training medical students and house staff. Research reveals that the habits learned or acquired during training persist into practice. Objectivity and scientific integrity should be central tenets of physician training. Academic medical centers are also in a position to take immediate action. They are sufficiently well organized to gain commitments to a set of new principles in relatively short time. Moreover, independent research into the impact of medications and devices on population health is concentrated in AMCs; therefore, unwarranted influence by manufacturers must be avoided. For these reasons, academic medicine should take the leadership in reforms, and other physicians and medical institutions should adopt their standards.” (Brennan TA et al., JAMA, 2006 http://jama.ama-assn.org/cgi/content/full/295/4/429)
State of AMCs: Assessing institutional policy environment
There is now a growing body of empirical data to support the establishment and evaluation of institutional policies and practices aimed at managing individual and institutional conflicts of interest in clinical care, particularly in the setting of academic medicine.
In September of 2007, IMAP undertook a survey of the nation’s 125 academic medical centers and their conflict of interest policies in clinical care. In addition to the questionnaire that focused on ten basic areas of policy, we requested copies of the schools’ policies. The result was an impressive and varied collection of policies and guidelines from well over three quarters of the schools surveyed.
Our forthcoming analysis of the survey indicates that only a fifth of all AMCs have strong policies restricting gifts, and even fewer than that have policies addressing meals, ghostwriting, speakers bureaus, samples among others.
Our research shows that many schools are in the process of revising and adding to their policies, a finding that is not surprising considering the increasing attention to transparency and addressing conflicts with industry among the healthcare profession.