Conflict of Interest Policies at French Medical Schools: Starting from the Bottom

Abstract

BackgroundMedical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009–2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention.MethodsWe searched the websites of all 37 French Faculties of Medicine in May 2015 for COI policies and curriculum, using standardized keyword searches. We also surveyed all deans of medicine on institutional COI policies and curriculum, based on criteria developed in similar US and Canadian surveys. Personal contacts were also consulted. We calculated a summary score per faculty based on 13 criteria. [range 0–26; higher scores denoting stronger policies]ResultsIn total, we found that 9/37 (24%) of French medical schools had either introduced related curriculum or implemented a COI-related policy. Of these, only 1 (2.5%) had restrictive policies for any category. No official COI policies were found at any of the schools. However, at 2 (5%), informal policies were reported. The maximum score per faculty was 5/26, with 28 (76%) scoring 0.ConclusionThis is the first survey in France to examine COI policies at medical faculties. We found little evidence that protection of medical students from undue commercial influence is a priority, either through institutional policies or education. This is despite national transparency legislation on industry financing of health professionals and limits on gifts. The French National Medical Students Association (ANEMF) has called for more attention to COI in medical education; our results strongly support such a call.

Conflict of Interest Policies at German medical schools - A long way to go

“…Our methodology built upon criteria used in earlier studies on COI policies such as the American Medical Students Association (AMSA) scorecard (29), the Canadian scorecard by Shnier et al (27), and the French conflict of interest ranking by Scheffer et al (28) A list of the 38 German medical schools was obtained from the website of the German Medical Faculty Association (Medizinischer Fakultätentag) (31). After formal exchange with a member of the German Ethics Council about the nature of this study, which only involves policies at an institutional level rather than patient data or other personal information, it was deemed unnecessary to ask for formal approval from an ethics committee.…”

“…Some of this research encouraged change among medical schools so that in 2014, 136 of 160 US medical schools had an existing policy on COI (29). In November of 2017, after a study was published which found no existing policies at any of the French medical schools (28), the French Deans' Conference of Medicine and Odontology Schools published an "Ethical and deontological Charter" (30) -effectively a COI policy for all French medical schools on a national level. In Germany, Lieb et al found that in 2013 only two medical schools reported having a COI policy (21).…”

“…Addresses of the websites searched are listed in the supplementary material. Search terms included "Interessenkonflikt"/"Interessenskonflikt" (conflict of interest), "Industrie" (industry), and "interne Regulierung" (internal regulation) based on previous publications (28). If a policy was in place, it was recorded together with the latest date of review.…”

“…We adapted a scoring system based on criteria used in earlier studies by Scheffer et al (28) and Shnier et al (27) in the French and Canadian context respectively, as well as the AMSA Scorecard (29). The following categories were addressed:…”

L’influence de l’industrie pharmaceutique sur la formation des étudiants en médecine : une situation paradigmatique de l’exigence d’une formation plus radicale à la pensée critique

“…Elles ont été reprises par l'Association nationale des étudiants en médecine de France, en partenariat avec le collectif Formindep, qui prône « une formation médicale indé-pendante au service des seuls professionnels de santé et des patients » [18] . Réagissant à la publication d'une étude issue de cette initiative, qui montrait que les facultés de médecine françaises s'étaient jusqu'à pré-sent peu préoccupées de vérifier la transparence des relations entre les universités et l'industrie pharmaceutique [19] , la Conférence des doyens des facultés de médecine, par la voix de son président, a promis d'engager des actions afin de « garantir l'indépen-dance des formations de toute interférence commerciale » [20] . En contexte nord-américain, de telles politiques sont édictées publiquement depuis plusieurs années, comme c'est le cas par exemple à l'Université Laval à Québec, qui met aussi l'accent sur la notion d'indépendance, en l'élargissant en l'occurrence à la notion « d'indépendance intellectuelle » [21] .…”