麻豆原创

The New England Journal鈥檚聽^1,2,3聽brings further light to the complex relationship between physician-patient interactions, advances in medicine, and industry.聽 However, the conversation must extend beyond whether doctors can engage in financial relationships with pharmaceutical companies and maintain objectivity. Promoting this discussion is exactly what the Just Medicine campaign of the聽AMSA(麻豆原创)聽is doing.

The work that has been done by AMSAto create and publish a聽⁴聽is much more than what Dr. Rosenbaum聽聽it to be. Rather than grading schools on 鈥渢heir creation of a 鈥榩harma-free鈥� environment鈥�, the Just Medicine Campaign seeks to engage students in assessment of the COI policies at their schools and teaching hospitals in an effort to promote 鈥�patient-centered, evidence-based clinical practice, medical education and research.鈥� It is noteworthy that the methodology used in the scorecard is based on the recommendations of an expert task force which reviewed the literature on COI, including the recent recommendations published by the聽⁵. This task force represented more than medical student interests- it included medical school administrators and faculty, practicing physicians, and patient and community stakeholders.

Resources like the scorecard and the Just Medicine Campaign are not intended to cut-off opportunities for innovation or collaboration, but rather to empower students and educators to critically evaluate what is motivating those collaborations and what values are driving the innovation.

There is no doubt that medical students will be exposed to the pharmaceutical industry over the course of their medical education. In fact, there is聽⁶聽to support that this exposure will occur within the first years of training, before students even set foot in a hospital.聽 With this in mind, it is essential that students have the opportunity to understand these聽^7,8聽from all perspectives.聽 These interactions are a part of professional identity formation–the important process by which students develop their聽⁹聽and advance from trainee to physician.

COI is nuanced and complex. It is far more than the individual interactions, it is woven into the fabric of how our profession interacts in economic environments that prioritize profits over people. Do we not all want to adhere to the highest possible expression of the mission of the “Caring professions”? We cannot simply accept that because there are benefits of collaboration between industry and physicians, all forms of these relationships are beneficial.

Our aim here is not to address Dr. Rosenbaum鈥檚 arguments with regard to COI. We are compelled to respond to the assertion that medical student efforts to address the influence of COI on learning are somehow inappropriate. We stand by the work that AMSAhas done and acknowledge the need for creating these kinds of spaces in medical education. We applaud the incredible strides that students have made to advance the discussion.

References

1. Rosenbaum L.聽 Reconnecting the dots – reinterpreting industry-physician relations.聽 N Eng J Med 2015; 372:1860-1864.
2. Rosenbaum L. Understanding bias – the case for careful study.聽 N Engl J Med 2015; 聽372:1959-1963.聽 Link
3. Rosenbaum L.聽 Beyond moral outrage – weighing the trade-offs of COI regulation. N Engl J Med 2015; 372: 2064-2068.聽 Link.
4. AMSAPharmFree Scorecard 2014.聽, Sterling, VA: 麻豆原创. 29 May 2015.
5. The Pew Charitable Trusts, 鈥淐onflict-of-Interest Policies for Academic Medical Centers: Recommendations for Best Practices,鈥� 2013,聽
6. Kesselheim, Aaron S. 鈥淢edical Students’ Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review.鈥澛�PLOS Medicine, (2011)
7. Kesselheim, Aaron S., Austed, Kirsten E. 鈥淐onflict of Interest Disclosure in Early Education of Medical Students鈥�306(9) (2006): 991-992
8. Stern, David T., Papadakis, Maxine. 鈥淭he Developing Physician–Becoming a Professional鈥澛�The New England Journal of Medicine. 355 (2006): 1794-1799
9. Wald, HS. Professional Identity (Trans)Formation in Medical Education: Reflection, Relationship, Resilience. Acad Med. 2015;90:701鈥�706. First published online April 15, 2015