Our research supplies the primary analysis of Scandinavian medical colleges’ COI insurance policies. The insurance policies had been primarily College-wide and though we discovered related insurance policies for all of the included establishments, the quantity and content material of insurance policies diversified extensively and there are nonetheless substantial shortcomings. Lack of restrictive insurance policies had been usually associated to points distinctive to medication. For instance, not one of the included colleges had a restrictive coverage for contacts with gross sales representatives and drug samples.
Strengths and limitations
A key power of our research is that it’s primarily based on a strong methodology that has been beforehand utilized in research from North America and Central Europe. We used a number of strategies (i.e., web site search and contacts with Deans) to retrieve related institutional insurance policies and every coverage was independently assessed by two coders. The research additionally has some limitations. First, we’d have missed related COI insurance policies as we used solely particular key phrases and insurance policies might have been listed below different phrases or might not be publicly out there. Furthermore, the various search engines can work otherwise on totally different Universities’ web sites. Nonetheless, we managed to get replies about related paperwork from 14 of 15 establishments. Second, we centered on COI insurance policies at medical college or College-wide stage and didn’t embrace insurance policies of educating hospitals or regional or nationwide laws except they had been explicitly talked about within the included COI insurance policies or on the medical college or College web sites. This implies our research supplies solely a partial image of the regulation in place in every of the included international locations. Third, the system we used for our evaluation has some limitations. For instance, it doesn’t deal with COI in analysis or how educational establishments cope with the danger of business funders’ affect on research design, evaluation, and reporting. Fourth, the outcomes of this research may underestimate the educating actions on COI as our evaluation of that merchandise was primarily primarily based on the training goals listed within the official medical curricula and never an examination of the educating supplies or content material of lectures. Fifth, we used the identical coding system for the evaluation of institutional insurance policies from the three international locations to permit for a cross nation comparability. Not tailoring the evaluation to every nationwide system may probably scale back granularity. Nonetheless, we imagine that the Scandinavian healthcare and schooling system is pretty just like enable for this technique. Lastly, whereas most Universities and colleges had mechanisms in place for oversight and sanctions for non-compliance, we didn’t assess the extent of enforcement.
Context and perspective
Related research of medical colleges in France and Germany discovered weak content material of COI insurance policies [9, 11]. Nonetheless, the outcomes of the opposite European research should not straight corresponding to ours as these research solely centered on medical colleges’ insurance policies whereas we additionally included insurance policies of the father or mother College (which represented the vast majority of the insurance policies in our pattern). The content material of COI insurance policies at Scandinavian medical colleges could be weaker had we excluded College-wide insurance policies. The shortage of medical college particular insurance policies is considerably hanging since a number of domains addressed by our evaluation system are distinctive for medication (e.g., drug samples and drug representatives) and won’t be coated by College-wide insurance policies suited to all schools.
Nonetheless, as beforehand talked about within the limitation part, we didn’t embrace insurance policies of educating hospitals or regional or nationwide regulation except they had been explicitly talked about within the included COI insurance policies. We made this resolution as we had been within the steering that College workers or college students can discover on the web site or within the official paperwork of their establishment. This implies our research supplies solely a partial image of the particular state of affairs in Scandinavia. For instance, clinically energetic lecturers at Scandinavian medical colleges are nearly at all times below a twin employment, each by the College and the related hospital which is run by the native authority. Equally, medical college students conducting scientific rotations at College related hospitals are obliged by hospital protocol to observe these similar guidelines and laws. A future research may examine COI insurance policies at Scandinavian educating hospitals as they play an necessary function in coaching of healthcare professionals. Moreover, some relationships with business are additionally regulated by nationwide legal guidelines or pointers. For instance, in Denmark, the distribution of drug samples is regulated by each a nationwide regulation  and the moral pointers of the Danish Pharmaceutical Trade and the Danish Medical Affiliation [15, 16]. In Sweden, college workers are thought-about civil servants and will observe authorized provisions governing “secondary employments” (e.g. consultancies), and presents and procurement attributable to threat of bribing . Moreover, since 2015 the moral pointers of the Swedish Pharmaceutical Trade prohibits firms from paying for healthcare professionals journey or lodging at conferences and conferences . In Norway, in keeping with the Well being Personnel Act, healthcare professionals should not obtain presents or different advantages that might unduly affect their actions . Extra moral steering on relationships with the pharmaceutical business can be supplied by skilled associations just like the Norwegian Medical Affiliation .
These examples illustrate the challenges with evaluating content material of COI insurance policies between totally different nations. Our findings of shortcomings within the official COI insurance policies of Scandinavian medical colleges don’t imply that the state of affairs in Scandinavia is problematic for the reason that business can be regulated at each hospital and nationwide ranges. Moreover, the relationships between healthcare professionals and the business are additionally managed by the moral pointers of the Scandinavian medical associations and the pharmaceutical business. Nonetheless, it’s value mentioning that these voluntary pointers are typically much less restrictive in comparison with legally-binding regulation . In mild of this, we imagine it can be crucial that College insurance policies additionally deal with the problem both by having strict insurance policies or clearly referring to relevant regulation and business pointers in order that workers have a single web site to go to as an alternative of needing to find out about a number of nationwide or regional legal guidelines, laws, and pointers.
Lastly, you will need to word that the presence of an institutional coverage doesn’t essentially imply that each one its provisions are precisely carried out, although, it may nonetheless present an necessary roadmap for employees and college students. The childhood of medical college play an necessary function in shaping future skilled behaviour and there may be additionally proof exhibiting that being skilled in an establishment with a strict COI coverage might result in extra rational drug prescribing behaviours . We encourage Scandinavian medical colleges to develop and implement extra restrictive COI insurance policies within the curiosity of each sufferers and society. Our research supplies a complete catalogue of recognized insurance policies, which establishments might use as a supply of inspiration to revise their present insurance policies.