A minority of US medical schools surveyed have adopted policies on conflicts of interest regarding financial interests held by the institutions, but at least two-thirds have policies applying to financial interests of institutional officials, according to a study in the Journal of the American Medical Association (subscription may be required).

The researchers surveyed deans of all 125 accredited allopathic medical schools in the US between February and December 2006 to assess the extent to which the schools have adopted policies concerning institutional conflicts of interest (ICOI). They received replies from 86, or 69 percent. They found that 38 percent have adopted an ICOI policy covering financial interests held by the institution, 37 percent are working on adopting a policy and 25 percent aren’t working on a policy, or simply didn’t know.

“Although it is encouraging that 38 percent of institutions are in the process of developing policies covering the institutions’ financial interests, wider adoption of ICOI policies covering these interests is imperative in light of the compelling interest of research integrity, protection of human subjects and preservation of public trust,” write the authors, whose work was funded by the Greenwall Foundation.

When it comes to individuals, however, the numbers are higher - 71 percent adopted policies for senior officials; 69 percent for mid-level officials; 81 percent for members of an institutional review board (IRB), and 66 percent for governing board members. As for working on a policy, 12 percent are working one for senior officials; 15 percent for mid-level officials; 8 percent for IRB members, and 3 percent for governing board members.

Most institutions treat as a conflict any financial interests held by an institutional research official for a research sponsor - 78 percent, to be exact - or for a product that’s the subject of research, again 78 percent. The majority of institutions have adopted organizational structures that separate research responsibility from investment management and from technology transfer responsibility. The researchers add, however, that gaps do exist in institutions informing their IRBs of potential ICOI in research projects under review.

“While acknowledging that adoption of ICOI policies is not a simple task and is dependent on, among other factors, highly interactive institutional databases and the active involvement of faculty, administrative officials, and the institution’s governing board(s), it is problematic that more schools do not have more comprehensive policies in place,” they conclude. “The gaps in coverage suggest the need for continuing attention by the academic medical community to more consistently and comprehensively address the challenges presented by ICOI.”

The Association of American Universities and the Association of American Medical Colleges have recommended policies regarding ICOI. The AMC, by the way, employs two of the five study authors.

In an accompanying editorial, David Rothman of Columbia University’s Center on Medicine as a Profession writes that “it is fair to ask whether it is naive to trust institutions to monitor and discipline their own financial activities, particularly when the financial returns can be substantial. Licensing agreements on patents generate close to $2 billion per year for academic research centers…At a time when federal research funding is declining and competition for philanthropic gifts is intensifying, universities may not be eager to promulgate policies that would restrict their freedom to maneuver.”