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Healthy Skepticism Library item: 16930

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Electronic Source

Thomas C
Pens, pizza, parties: how Big Pharma freebies impact your doctor
The Ethical Nag 2009 Dec 8

Full text:

For many years, pharmaceutical companies have supplied free lunches – and even fridges to store them in – in the student lounges of Canadian medical schools. Well, if the association that represents Canada’s medical schools has anything to say about it, there really will be no such thing as a free lunch – at least for medical students. This also means no more talks given by physician experts paid by pharmaceutical companies. No more unsupervised meetings with drug reps. Recently, several other university medical centres, including Yale University and the University of Pennsylvania, have also barred drug company sales reps from bringing free lunches to staff physicians. And in September, Stanford University announced that its physicians will no longer be able to accept gifts of any size from any type of vendor, including drug companies and medical device makers.

“It’s a slippery slope from pens and Post-Its to bigger gifts. It is more clearcut just to say don’t take anything.’” Ethicist Dr. Richard Popp at Stanford’s biodesign program.

The Association of Faculties of Medicine of Canada said their aim is to limit the influence that the pharmaceutical industry has on medical students and residents, as well as to address the public’s concerns about the perceived coziness between medical schools and Big Pharma. Dr. Irving Gold of the AFMC described from Ottawa the potential impact of drug company relationships on these students:

“There’s no question that the environment within which you’re trained will have an impact on the way you perceive these issues. The public has to trust that the doctors they see do not have any debts to pay to individual pharmaceutical companies or to the sector as a whole.”

Surprisingly, and despite physicians’ insistence that they are not influenced at all by receiving Big Pharma gifts, a review published in the Journal of the American Medical Association shows that even the smallest of gifts does indeed influence the choices physicians make. Psychologists call it reciprocity-the natural human tendency to want to give something back to the gift-giver. It’s the same phenomenon that prompts charitable organizations to fill people’s mailboxes with return address labels so they’ll be more likely to feel obligated to make a donation.

To explore the extent of the possible influence of these gifts on which drugs physicians ultimately choose to prescribe, Dr. Ashley Wazana, a doctor and psychiatry resident at McGill University in Montréal, reviewed 29 studies on doctors’ prescribing behaviour in the U.S., Canada, Holland, New Zealand, and Australia.

In his review, Dr. Wazana noted that:

free samples, honorariums, and research grants led doctors to be significantly more likely to prescribe that drug freebies also led doctors to request the drug for formularies (hospitals’ official lists of drugs that can be prescribed there) hearing a drug salesman at a talk led doctors to recommend “inappropriate treatment” more often than other doctors, including treatment that cost more and was more invasive residents who heard drug reps speak at lunch rounds were more likely to have inaccurate information about drugs on the market accepting a free trip to a company-sponsored conference led doctors to increase prescriptions of that company’s drugs by 80-190%. doctors who “occasionally” attended pharma-sponsored meals were 2-3 times more likely than other doctors to request that the sponsor’s drug be added to a hospital formulary doctors who “often” ate these meals were 14 times more likely to do so most doctors and residents are in some way interacting with drug companies four out of five medical residents attended industry-paid meals, with the average resident eating on the corporate dime 14-15 times a year interns averaged free meals on the corporate dime 31 times a year medical residents got an average of six gifts per year worth $60 each 85% of doctors said they had some interaction with drug reps, with an average of three to four encounters a month 86% of doctors accepted free drug samples, and half got research grants two out of five doctors attended company-sponsored meals, and a similar proportion accepted funding for travel or lodging to attend company-backed conferences Yet despite all this, just one in five doctors agreed that pharma reps “fairly portray their product”, and three-quarters of medical residents said reps “may use unethical practices”; 44% said that reps “provide misleading information”.

Paradoxically, many doctors still rely on drug company sales staff more than any other source for information about new drugs-and not just in North America. One-third of U.K. doctors said pharmaceutical industry reps were their most important source of initial information on new drugs, and pharmaceutical ads accounted for another 15%, according to a 2002 survey in the British journal Family Practice. This study also reviewed 616 prescriptions the doctors had written. The doctors cited pharma reps more often than any other factor in influencing their prescription choice. The reps were cited 39% of the time, far more than concern about the drug’s side effects (17%) or prescribing guidelines developed by the medical community (15%).

Several American states have already initiated controls on cozy physician-Big Pharma links. Read this Wall Street Journal article on what New Jersey’s Attorney General is now recommending.


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