Industry Exposure in Medical Training: The Case for a Conflict-Free Learning Environment

Conflicts of interest (COI) between physicians and for-profit companies have existed for centuries, but the last decade has dramatically increased their visibility through the Centers for Medicare and Medicaid Services' Open Payments database. Despite growing documentation of COI in academic medical environments - where financial relationships are prevalent and industry payments to trainees exceed millions of dollars annually - formal COI policies and curriculum in US medical schools have stagnated or weakened since the last major wave of reform over a decade ago. The authors review the evidence linking industry interactions during medical training to favorable views of pharmaceutical marketing, greater propensity for continued industry engagement, and increased prescribing of promoted drugs and devices. The authors argue that medical schools and their governing bodies must implement and enforce meaningful COI policies, meeting at minimum the Association of American Medical Colleges' existing recommendations. The authors further recommend that the Liaison Committee on Medical Education require adherence to these policies for annual accreditation, that research curricula address the influence of funding sources on study design, and that the Open Payments database be integrated into medical training as a transparency tool. Strengthening COI education and policy is essential to ensure that the next generation of physicians learns in environments where patient-centered, evidence-based medicine guides decision-making.