per year for 3 years), and no recipient would be identified as having been funded by a particular company or companies.

Responses

AAMC (2008c) recommends that academic medical centers establish and implement policies requiring that industry funds for scholarships and similar purposes be given centrally to the administration of the medical center. In addition, industry should have no involvement in the selection of recipients, and no “quid pro quo [should] be involved in any way” (p. 21). The objective is to “prevent the establishment of one-on-one relationships between industry representatives and students and trainees” and minimize “the possibility that these funds will be perceived or used as direct gifts” (p. 21). The committee supports the AAMC recommendations. AMA and PhRMA both permit industry funding of scholarships for medical students, residents, or fellows to attend carefully selected educational conferences when the selection of recipients is made by the academic or training institution.

Changing the Environment or Creating Educational Interventions

To the extent that industry influence operates at an unconscious level, the most effective strategies for reducing the risk of undue influence may involve changing the environment in ways that eliminate or reduce the source, especially when the source offers little or no countervailing educational benefit. That is a major rationale for the policies cited above that eliminate gifts, meals, and other noneducational interactions from the learning environment. Some evidence suggests that the learning environment influences attitudes. Two studies have reported that residents who trained in environments that restricted interactions between industry representatives were less likely than residents who trained in environments without such restrictions to view promotional interactions as being beneficial (Brotzman and Mark, 1993; McCormick et al., 2001). One literature review found weak evidence that trainees who were exposed to educational interventions may be “less accepting of pharmaceutical industry marketing tactics” than those who are not (Carroll et al., 2007, p. e1533). The review noted that two studies that involved industry personnel in the design of the educational intervention found that the participants were more positive toward industry and industry representatives than they were before the intervention.

Some research—including research in academic medical centers as well as community settings (see, e.g., Solomon et al. [2001])—suggests the value of “academic detailing” or educational outreach programs provided by clinical pharmacists or other experts as an objective educational alternative



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