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Pharma Phacts FAQ

What does the evidence say?

As medical students we all learn how to use evidence based medicine to guide best practice for our patients. This section is designed to provide you with the evidence that exists so that you, as an individual medical student, can make your own mind up about the pharmaceutical industry.

Let’s start with some systematic reviews.

Pharmaceutical Marketing negatively influences prescribing practice, attitudes towards pharmaceutical representatives and medical knowledge.

Wazana looked at 29 studies investigating the extent of the physician-industry interaction, attitudes of physicians toward the interaction, and the effect of the interaction on the practitioner. This concluded that most studies had resulted in negative outcomes from the pharmaceutical industry and physician relationship including:

an impact on knowledge (inability to identify wrong claims about medication)
attitude (positive attitude toward pharmaceutical representatives; awareness, preference, and rapid prescription of a new drug)
and behavior (making formulary requests for medications that rarely held important advantages over existing ones; non-rational prescribing behavior; increasing prescription rate; prescribing fewer generic but more expensive, newer medications at no demonstrated advantage.)

Read the systematic review here.

Wazana, A, Physicians and the Pharmaceutical Industry: Is a Gift ever just a gift? JAMA. 2000;283(3):373-380.
http://jama.ama-assn.org/cgi/content/abstract/283/3/373

Pharmaceutical sponsorship affects research quality and publication

A systematic review of pharmaceutical industry sponsorship of clinical trials and the impact on research outcome and quality found that research sponsored by the drug industry was more likely to produce results favoring the product made by the company sponsoring the research than studies funded by other sources. Research funded by pharmaceutical companies was also less likely to be published if it showed unfavorable results. The authors suggest that there is a systematic bias to the outcome of published research funded by the pharmaceutical industry.

Read the systematic review here.

Lexchin, J et al. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326:1167–70.
http://www.bmj.com/cgi/content/full/326/7400/1167

Research into medical students

The most recent evidence to come out in May 2009 shows that even subtle small branded promotional items has a positive effect on medical students. In this randomized control trial medical students exposed to clipboards and notepads had a significant implicit preference for the promoted drug as compared to the control group, while they were self-reporting as the promotions having had no effect on them!
The study also compared two medical schools, one with a restrictive policy on pharmaceutical marketing and one without and found that open door policy to pharmaceutical marketing result in students being less aware of their prescribing practices being affected. 63.3% of students at the restricted university agreed that gifts and food from pharmaceutical sales representatives would influence their eventual prescribing in contrast to just 29.4% at the university without a policy governing pharmaceutical marketing (P_.001). Two-thirds (66.7%) of students at the restricted university agreed that the school should exclude sales representatives from meeting with students in comparison to just 17.5% at the other university (P_.001).

Read the article here.

David Grande, MD, MPA; Dominick L. Frosch, PhD; Andrew W. Perkins, PhD; Barbara E. Kahn, PhD, ‘Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences’, Arch Intern Med. 2009;169(9):887-893.
http://archinte.ama-assn.org/cgi/content/short/169/9/887

The following are studies, mostly done in the United States, which examine medical student knowledge and attitudes towards the pharmaceutical industry.
Hyman, PL, Hochman ME, Shaw JG, Steinman MA, ‘Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry’ Academic Medicine 2007 Jan;82(1):94-9.
A total of 107 (26%) students believed that it is appropriate for medical students to accept gifts from pharmaceutical companies, and 76 (18%) agreed that the medical school curriculum should include events sponsored by the pharmaceutical industry. Many students-253 (61%)- reported that they do not feel adequately educated about pharmaceutical industry– medical professionals’ interactions. Preclinical and clinical students had similar opinions for the majority of their responses. Finally, students who reported feeling better educated about pharmaceutical industry interactions tended to be less skeptical of the industry and more likely to view interactions with the industry as appropriate.
Read the article here.
http://www.ncbi.nlm.nih.gov/pubmed/17198299?log$=activity

Sandberg WS, Carlos R, Sandberg EH, Roizen MF. The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or products. Acad Med 1997; 72: 916-918.

This US study evaluated students receiving textbooks from pharmaceutical companies; 90% has received a textbook, 89% could accurately recall the titles but only 25% of the names books were accurately associated with a pharmaceutical company or product.

Read the article here.
http://www.ncbi.nlm.nih.gov/pubmed/9347716?log$=activity

Fitz MM, Homan D, Reddy S, Griffith CH 3rd, Baker E, Simpson KP, ‘The hidden curriculum: medical students’ changing opinions toward the pharmaceutical industry.’ Academic Medicine 2007 Oct;82(10 Suppl):S1-3.

This US study found that sixty-five percent of clinical students believed accepting gifts was appropriate; 28% of preclinical students believed it was appropriate (P _ .001). Knowledge was the same for clinical and preclinical students.

Read the article here.

http://www.ncbi.nlm.nih.gov/pubmed/17895670?log$=activity

McCormack, BB. Effect of Restricting Contact Between Pharmaceutical Company Representatives and Internal Medicine Residents on Posttraining Attitudes and Behavior. JAMA, October 24/31, 2001-Vol 286, No. 16.

This study established that early contact with pharmaceuticals is more likely to be associated with a positive attitude towards pharmaceutical companies and more frequency of visits later in life. A study comparing two internal medicine training facilities, McMaster University Department which initiated a policy in 1992 restricting Pharmaceutical Company Representative (PCR) in Hamilton, Ontario compared to University of Toronto, Toronto, Ontario who has no such policy.1 The post-policy McMaster trainees were less likely to find information from PCRs beneficial in guiding their practice compared to the Toronto and prepolicy McMaster trainees. Post policy McMaster trainees also had a lower current contact score with PCR compared to Toronto and pre policy McMaster trainees. Greater frequency of contact with PCR’s during training was a predictor of increased perceived benefit of PCR information and was positively correlated with the current contact score with PCR.

Read the article here.

http://jama.ama-assn.org/cgi/content/full/286/16/1994

 

 

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Pharma Phacts are a medical student group committed to raising awareness about pharmaceutical companies and their interactions with medical students.