Study Shows Physicians Unaware of Industry Influence
Physicians' prescribing practices do change based on gifts such as meals,
conferences, and other perks received from drug companies, according to
a just-published study in the Journal of the American Medical Association.
Interactions between physicians and the pharmaceutical industry are not
as innocuous as they seem. Pharmaceutical companies spend more than $11
billion each year to promote and market drugs -- an estimated $8,000-$13,000
per physician per year. This money is often spent in the form of meals and
entertainment as physicians listen to discussions about a particular medication,
or as money for books or medical supplies, for example.
Physicians are human; they are not exempt from the usual standards when
it comes to receiving gifts. Many other industries have explicit principles
saying, 'No one in this company accepts gifts from suppliers or contractors.'
Why should doctors be different? Physicians are in a strange position because
they write prescriptions for other people to purchase. They are making decisions
that affect the expenses of others, not their own. It's what you might call
a fiduciary relationship. They need to be extremely careful to make those
decisions in a rational, unbiased way.
The JAMA researcher reviewed 29 studies that addressed the interactions
between physicians and the pharmaceutical industry. Most of the articles
showed that physicians' prescribing practices are, in fact, affected by
these relationships with drug companies. For example, they tend to prescribe
fewer generic medications and more new, expensive drugs even when the drugs
don't have any advantages over cheaper medications. Just because something
is the most recent and most costly medication doesn't mean it's the most
effective. But we all tend to believe in the myth of progress. Many physicians
are at a loss on how to keep up with so much information about new medications,
so talking with the pharmaceutical representative is very convenient.
The researcher reports evidence of four types of influence. Following drug
company overtures to physicians, physicians prescribed a drug manufactured
by the sponsor of a medical education program more frequently, hospitals
increased their prescribing of a conference travel sponsor's drug, residents
increased "nonrational" prescribing of a drug following a meeting with by
a company representative, and attitudes about drug company representatives
became more positive. The researcher noted that interactions between MDs
and pharmaceutical representatives begin in medical school and continue
at a rate of about four meetings per month.
In an accompanying editorial, Dr. Robert M. Tenery, Jr., of the American
Medical Association's Council on Ethical and Judicial Affairs, writes that
the Council has attempted to police physician interactions with drug companies.
The most egregious activities have stopped, such as awarding airline miles
for prescriptions written, but recently the need for continuing medical
education (CME) has driven a resurgence of drug company-sponsored junkets,
he says. CME credit is a requirement for licensing in most states. Tenery
notes that drug company money and influence "has permeated virtually all
levels of physician CME in the form of complimentary meals and entertainment,
consultation fees, and pseudo-CME courses." He concludes that physicians
and the drug industry need to develop new industry-wide standards to prevent
abuses of the system.
http://my.webmd.com/content/article/1728.541655
The Journal of the American Medical Association
2000;283:373-380, 391-393.
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