Kansas University School of Medicine received a “C” for its rules governing conflicts of interest with pharmaceutical companies, according to a recent report.

But a KU official who helped spearhead ethics guidelines in dealing with the pharmaceutical industry said the school was on the right track by allowing doctors in training to be exposed to industry practices.

“It’s far more important that our graduates come out understanding that process rather than being totally isolated from it,” said Dr. David Robbins, a professor of medicine.

Ethical questions about the relationships between doctors and drug companies have been raging for years.

Pharmaceutical industry marketing to doctors has been estimated at $28 billion to $46 billion per year, with additional promotion by the medical device industry, according to the American Medical Student Association.

This spending on free lunches, gifts, medication samples and promotional literature averages $35,000 per year in marketing directed at each physician, the group reported.

The presentations and personal relationships are designed to influence doctors to prescribe more drugs and more expensive drugs and have often become a substitute for objective medical evidence, AMSA said.

“It is time to extricate marketing practices from medical education,” said Dr. Brian Hurley, AMSA’s national president.

“There is substantial evidence that marketing shapes physician prescribing habits. By eliminating the gifts and the misleading information that pharma reps currently bring into our schools, hospitals and academic medical centers, physicians will be able to better practice evidence-based medicine. And that translates into better care for our patients,” he said.

The “PharmFree Scorecard” assessed policies at medical schools nationwide. The report evaluated restrictions on gifts, paid speaking for products, acceptance of drug promotion samples, interaction with sales representatives and industry-funded education.

Of the 150 medical schools in the United States, there were 7 A’s; 14 B’s; 4 C’s; and 19 D’s. The remaining schools either failed, declined to participate or were in the process of updating their policies.

KU School of Medicine received high marks in some areas but low marks in others to earn a cumulative C.

For example, KU was credited for having strong policies that ban gifts from pharmaceutical and medical device companies, and that limit consulting agreements.

But the report said: “The institution is considerably weaker on speakers bureaus (permitted), samples (permitted) and purchasing decisions (recusal not automatic).”

Speakers bureaus are formed by pharmaceutical companies to get doctors to speak on behalf of their products for a fee. The KU School of Medicine “weakened its ban on speakers bureaus to discouragement of them,” the report said.

AMSA also recommends that schools ban doctors from giving free pharmaceutical samples to patients because once the sample runs out, the patient is prescribed the sample medicine when often there is a less expensive, generic alternative.

But KU’s Dr. Robbins said AMSA was seeking to create an “iron wall” between pharmaceutical companies and academic medicine.

He said doctors need to hear from pharmaceutical companies but also be able to discern fact from hype.

“Our obligation is to teach residents and staff how to be objective and use information from all sources to provide the best care,” he said.