Physicians and the Pharmaceutical Industry: are Doctors really immune to Marketing?

2000 Study Abstract

Context
Controversy exists over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend a large sum of money each year promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and symposia.

Objective
To identify the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians.

Data Sources
A MEDLINE search was conducted for English-language articles published from 1994 to present, with review of reference lists from retrieved articles; in addition, an Internet database was searched and 5 key informants were interviewed.

Study Selection
A total of 538 studies that provided data on any of the study questions were targeted for retrieval, 29 of which were included in the analysis.

Data Extraction
Data were extracted by 1 author. Articles using an analytic design were considered to be of higher methodological quality.

Data Synthesis
Physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about 4 times per month. Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company–sponsored continuing medical education (CME) preferentially highlighted the sponsor’s drug(s) compared with other CME programs. Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor’s medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing.

Conclusion
The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.

There are few issues in medicine that bring clinicians into heated discussion as rapidly as the interaction between the pharmaceutical industry and the medical profession.

• More than $11 billion is spent each year by pharmaceutical companies in promotion and marketing, $5 billion of which goes to sales representatives.
• It has been estimated that $8000 to $13,000 is spent per year on each physician.
• The attitudes about this expensive interaction are divided and contradictory.
  • One study found that 85% of medical students believe it is improper for politicians to accept a gift,
  • whereas only 46% found it improper for themselves to accept a gift of similar value from a pharmaceutical company.
• Most medical associations have published guidelines to address this controversy. Perhaps the intensity of the discussion is related to the potential consequences were it confirmed that gifts influence prescription of medication that results in increasing cost or negative health outcomes.

This article addresses the question by way of a critical examination of the evidence. Two review articles have addressed the factors affecting drug prescribing, but only 1 has focused on the impact of the physician-industry interaction on the behavior of physicians. This article critically examines the literature and highlights articles with rigorous study methods.

Sources and more information

• Physicians and the Pharmaceutical Industry, Is a Gift Ever Just a Gift?, JAMA. 2000;283(3):373-380. doi:10.1001/jama.283.3.373, articleid=192314, January 19, 2000.
• Pharmaceutical marketing to doctors harms our profession and our patients, theguardian, 2015/mar/02.
• Doctors are divided: how much to reveal about the Gifts they get from #BigPharma.
• About the No Advertising Please Campaign.
• Our posts tagged medical representatives.