Physicians have frequent contact with pharmaceutical firms and their sales personnel, who spend substantial sums in the form of gifts, free meals and travel, and sponsored educational programs. The implications of these practices and attitudes about the physician-industry relationship were examined by conducting a MEDLINE search for English-language articles published since 1994. An internet database also was searched, and five key informants were interviewed. Of 538 articles providing relevant data, 29 that were published in peer-reviewed journals were analyzed. Sixteen of them dealt with the extent of physician-industry interactions. The same number of articles identified physician attitudes, and 16 of the articles examined the effect of the interaction on the practitioners. A majority of studies used a self-reporting cross-sectional survey design. Response rates ranged from 30 percent to 100 percent.
Interactions began as early as medical school. Most physicians met with pharmaceutical company representatives approximately four times a month starting in the residency years. As physicians left residency and began practicing, industry-sponsored meals and samples were replaced to some extent by honoraria, conference travel, and research funding. Both residents and physicians believe that the representatives provide accurate drug information, but they also reported believing that they place product promotion ahead of patient welfare and are likely to use unethical practices. Most physicians deny that gifts might influence their behavior. They see drug samples, continuing medical education, and conference travel funding as having more influence than promotional materials. Interactions with pharmaceutical representatives seemed to influence the prescribing practices of residents and physicians. Those accepting gifts professed to believe that the representatives have no effect on their prescribing behavior. Samples, in general, were associated with positive attitudes toward industry. Accepting funds to attend a symposium correlated with increased requests for the sponsor’s drug. Physicians participating in sponsored continuing medical education programs changed their prescribing practices in favor of the sponsor’s drug. Accepting an honorarium to present information on a new treatment and receiving research support correlated with requests for the sponsor’s drug but also for any drug.
This survey suggests that interactions between resident and postresident physicians and the pharmaceutical industry do influence prescribing behavior. These issues should be addressed at both the educational and policy-making levels.
JAMA 2000;283:373–380
