Douglas P. Olsen is an associate professor at Michigan State University College of Nursing in East Lansing and a contributing editor of AJN. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise.
[Show abstract][Hide abstract] ABSTRACT:
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
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.1- 4
More than $11 billion is spent each year by pharmaceutical companies in promotion
and marketing, $5 billion of which goes to sales representatives.5- 6 It has been estimated that $8000 to
$13,000 is spent per year on each physician.7- 8
The attitudes about this expensive interaction are divided and contradictory.
One study9 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 articles10- 11
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.12 This article critically examines the literature and
highlights articles with rigorous study methods.
JAMA The Journal of the American Medical Association 01/2000; 283(3):373-380. DOI:10.1001/jama.283.3.373 · 30.39 Impact Factor
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