Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey
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Increasingly, medical school policies limit pharmaceutical representatives’ access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.
To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students’ practices and attitudes.
We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.
We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees’ attitudes and their schools’ National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.
Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38–0.68, p < 0.001), but the strength of institutional conflict of interest policies was not associated with this variable.
Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school’s policies concerning interactions with industry.
- Brody, H (2009) Pharmaceutical industry financial support for medical education: benefit, or undue influence?. J Law Med Ethics 37: pp. 451-460 CrossRef
- Campbell, EG, Regan, S, Gruen, RL, Ferris, TG, Rao, SR, Cleary, PD, Blumenthal, D (2007) Professionalism in medicine: results of a national survey of physicians. Ann Intern Med 147: pp. 795-802 CrossRef
- Steinbrook, R (2011) Future directions in industry funding of continuing medical education. Arch Intern Med 171: pp. 257-258 CrossRef
- Avorn, J, Choudhry, NK (2010) Funding for medical education: maintaining a healthy separation from industry. Circulation 121: pp. 2228-2234 CrossRef
- Campbell, EG, Weissman, JS, Ehringhaus, S, Rao, SR, Moy, B, Feibelmann, S, Goold, SD (2007) Institutional academic industry relationships. JAMA 298: pp. 1779-1786 CrossRef
- Zipkin, DA, Steinman, MA (2005) Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med 20: pp. 777-786 CrossRef
- Fitz, M, Homna, D, Reddy, S, Griffith, C, Baker, E (2007) The hidden curriculum: medical students’ changing opinions toward the pharmaceutical industry. Acad Med 82: pp. S1-S3 CrossRef
- Bellin, M, McCarthy, S, Drevlow, L, Pierach, C (2004) Medical students’ exposure to pharmaceutical industry marketing: a survey at one U.S. medical school. Acad Med 79: pp. 1041-1045 CrossRef
- Hyman, P, Hochman, M, Shaw, J, Steinman, M (2007) Attitudes of preclinical and clinical medical students toward interactions with the pharmaceutical industry. Acad Med 82: pp. 94-99 CrossRef
- Fein E, Vermillion M, Uijtdehaag S. Pre-clinical medical students’ exposure to and attitudes toward pharmaceutical industry marketing. Med Educ. Online 2007;12. Available at: http://www.med-ed-online.net/index.php/meo/article/viewArticle/4465.
- Sierles, FS, Brodkey, AC, Cleary, LM, McCurdy, FA, Mintz, M, Frank, J, Lynn, DJ, Chao, J, Morgenstern, BZ, Shore, W, Woodard, JL (2005) Medical students’ exposure to and attitudes about drug company interactions: a national survey. JAMA 294: pp. 1034-1042 CrossRef
- Soyk, C, Pfefferkorn, B, McBride, P, Rieselbach, R (2010) Medical student exposure to and attitudes about pharmaceutical companies. WMJ 109: pp. 142-148
- Austad, KE, Avorn, J, Kesselheim, AS (2011) Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review. PLoS Med 8: pp. e1001037 CrossRef
- Wazana, A (2000) Physicians and the pharmaceutical industry: is a gift ever just a gift?. JAMA 283: pp. 373-380 CrossRef
- Bowman, MA, Pearle, DL (1988) Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Contin Educ Health Prof 8: pp. 13-20 CrossRef
- Sondergaard, J, Vach, K, Kragstrup, J, Andersen, M (2009) Impact of pharmaceutical representative visits on GPs’ drug preferences. Fam Pract 26: pp. 204-209 CrossRef
- Institute of Medicine. Conflict of interest in medical research, education, and practice. Washington, D.C.: National Academies Press; 2009.
- Association of American Medical Colleges. Industry funding of medical education: report of an AAMC task force. June 2008. Available at: https://members.aamc.org/eweb/upload/Industry%20Funding%20of%20Medical%20Education.pdf. Accessed 14 Jan 2013.
- Stanford School of Medicine. New policy on continuing medical education. 19 Aug 2008. Available at: http://med.stanford.edu/coi/documents/deanpizzo_cmeletter.pdf. Accessed 14 Jan 2013.
- Pharmaceutical Research and Manufacturers of America. PhRMA code on interactions with healthcare professionals. July 2008. Available at: http://www.phrma.org/sites/default/files/369/phrma_marketing_code_2008-1.pdf . Accessed 14 Jan 2013.
- University of Iowa health care conflict of interests and conflict of commitment policy regarding interactions with industry. 20 January 2009. Available at: http://www.healthcare.uiowa.edu/cme/planning/documents/FinalCOIPolicy.pdf. Accessed 14 Jan 2013.
- Fugh-Berman, A, Brown, SR, Trippett, R, Bell, AM, Clark, P, Fleg, A, Siwek, J (2011) Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions. Acad Med 86: pp. 649-654 CrossRef
- Kao, AC, Braddock, C, Clay, M, Elliott, D, Epstein, SK, Filstead, W, Hotze, T, May, W, Reenan, J (2011) Effect of educational interventions and medical school policies on medical students’ attitudes toward pharmaceutical marketing practices: a multi-institutional study. Acad Med 86: pp. 1454-1462 CrossRef
- Weissman, JS, Betancourt, J, Campbell, EG, Park, ER, Kim, M, Clarridge, B, Blumenthal, D, Lee, KC, Maina, AW (2005) Resident physicians' preparedness to provide cross-cultural care. JAMA 294: pp. 1058-1067 CrossRef
- US News. Best medical schools: research. 2011. Available at: http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings. Accessed 14 Jan 2013.
- American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. 2009. Available at: http://www.aapor.org/AM/Template.cfm?Section=Standard_Definitions1&Template=/CM/ContentDisplay.cfm&ContentID=1814. Accessed 14 Jan 2013.
- Johnson, TP, Wislar, JS (2012) Response rates and nonresponse errors in surveys. JAMA 307: pp. 1805-1806 CrossRef
- Kesselheim, AS, Mello, MM, Studdert, DM (2011) Strategies and practices in off-label marketing of pharmaceuticals: a retrospective analysis of whistleblower complaints. PLoS Med 8: pp. e1000431 CrossRef
- Mullan, F, Chen, C, Petterson, S, Kolsky, G, Spagnola, M (2010) The social mission of medical education: ranking the schools. Ann Intern Med 152: pp. 804-811 CrossRef
- Chimonas, S, Brennan, TA, Rothman, DJ (2007) Physicians and drug representatives: exploring the dynamics of the relationship. J Gen Intern Med 22: pp. 184-190 CrossRef
- Chren, M-M, Landefeld, CS (1994) Physicians’ behavior and their interactions with drug companies: a controlled study of physicians who requested additions to a hospital drug formulary. JAMA 271: pp. 684-689 CrossRef
- Manchanda, P, Honka, E (2005) The effects and role of direct-to-physician marketing in the pharmaceutical industry: an integrative review. Yale J Health Policy Law Ethics 5: pp. 785-812
- Avorn, J, Chen, M, Hartley, R (1982) Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 73: pp. 4-8 CrossRef
- Agrawal, S, Saluja, I, Kaczorowski, J (2004) A prospective before-and-after trial of an educational intervention about pharmaceutical marketing. Acad Med 79: pp. 1046-1050 CrossRef
- Austad, KE, Kesselheim, AS (2011) Conflict of interest disclosure in early medical education: should medical students stay in the dark?. JAMA 306: pp. 991-992 CrossRef
- Asch, DA, Jedrziewski, MK, Christakis, NA (1997) Response rates to mail surveys published in medical journals. J Clin Epidemiol 50: pp. 1129-1136 CrossRef
- Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey
Journal of General Internal Medicine
Volume 28, Issue 8 , pp 1064-1071
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- pharmaceutical industry
- undergraduate medical education
- drug promotion
- conflict of interest
- Industry Sectors
- Author Affiliations
- 1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA
- 2. Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA, USA
- 3. Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA