The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.

BACKGROUND: Best practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007. This report describes the methodological update and impact of revisions to the scorecard in 2014. METHODS: The original AMSA scorecard (used annually from 2008 to 2013) was revised by a work group to improve its methodology and to increase the stringency of its criteria for scoring COI policies. All U.S. medical schools (both allopathic and osteopathic; n = 160) were invited to submit their COI policies to AMSA for scoring with the new scorecard; web site searches were used to acquire policy information for schools that did not submit. The authors developed a codebook and analyzed 14 distinct categories of COI policies, pertaining to activities such as industry-funded gifts, meals, educational events, site access for sales reps, and conflict-of-interest disclosure requirements. The analysis yielded four possible grades for each school: A, B, C, or I (incomplete). The authors compared 2014 grades with 2013 grades, and compared the distribution of grades of schools by type (allopathic vs. osteopathic) and geographical region. RESULTS: A total of 27 (16.9 %) medical schools scored A grades, indicating that their COI policies were strong, 81 (50.6 %) scored B, 25 (15.6 %) scored C and 26 (16.3 %) policies scored I. As compared to 2013, in 2014 fewer schools qualified for A grades (17.0 % vs. 26.0 %; p = 0.05). The grade distributions of allopathic and osteopathic schools were significantly different (p < 0.0001), with osteopathic schools more likely than allopathic schools to have incomplete policies. There were no significant grade differences by geographical region. CONCLUSIONS: The revised 2014 AMSA scorecard, with its more stringent criteria for evaluating COI policies, assigned fewer As and more Bs and Cs than in years past. This was the first study to identify schools with COI policies stronger than those recommended in 2008 by the Association of American Medical Colleges. Developing more stringent COI policies should be helpful in reducing the influence of pharmaceutical and device industry marketing on both trainees and faculty in American medical schools.

Evidence-based somatic treatment of depression in adults.

The efficacy of antidepressants has become a contentious topic over the last decade, and yet a review of the literature shows that they are consistently more effective than placebo. Although the average magnitude of this effect is unclear, many individual patients respond well to a course of antidepressants, and relapse when the medication is discontinued. Choosing the right antidepressant for a given patient remains more art than science, but the studies reviewed here provide some helpful guidance. Table 4 lists the second-generation antidepressants along with potential reasons for choosing one over the other (based on side effects, costs, or possible therapeutic advantages.) Based on these data, the following conclusions can be drawn: • For an all-around first-line antidepressant, sertraline is hard to beat, given its combination of efficacy, tolerability, and low expense. Once escitalopram becomes generic, it will join sertraline in this category. • Bupropion is often a first-line alternative to sertraline, because of its lack of sexual side effects; although it has less efficacy for anxiety disorders, it is helpful for other comorbidities, such as tobacco dependence and attention-deficit/ hyperactivity disorder. • Both paroxetine and mirtazepine are often maligned because of side effects of sedation and weight gain; however, these side effects may be advantageous for those whose depressive symptoms include insomnia and excessive weight loss. • Although not specifically reviewed in this article, certain antidepressants are liable to cause more drug­drug interactions than others; the most prominent of these are fluoxetine, paroxetine, and fluvoxamine.

My favorite tips for sorting out diagnostic quandaries with bipolar disorder and adult attention-deficit hyperactivity disorder.

A review of some practical interviewing techniques for assessing the presence of bipolar disorder and attention-deficit/hyperactivity disorder. Case studies and interview excerpts illustrate the key interviewing techniques.