Skip to main content
SpringerLink
Log in

The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem

  • Perspective
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

To describe and examine the role of the pharmaceutical industry in the teaching of psychopharmacology to residents and medical students and to make recommendations for changes in curriculum and policy based on these findings.

Methods

Literature reviews and discussions with experts, educators, and trainees.

Results

The pharmaceutical industry currently plays an extensive role in teaching psychopharmacology to trainees, both directly and indirectly. Attendance at industry-sponsored lectures and drug lunches, meetings with pharmaceutical representatives, and interactions involving the acceptance of various gifts are the most obvious venues. Less apparent but equally pervasive are the influence of industry-sponsored faculty and research and industry’s effect on the climate of practice and the profession as a whole. Replacing medical education with industry promotion in the guise of scholarship causes demonstrable harm to trainees, the public and the profession.

Conclusions

In light of these findings, the medical profession must reassert control of medical education and draw a firm barrier between commercial and professional pursuits. These issues must be actively, explicitly, and rigorously discussed with our colleagues and students.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sigworth SK, Cohen GM: Pharmaceutical branding of resident physicians. JAMA 2001; 286: 1024–1025

    Article  CAS  PubMed  Google Scholar 

  2. Bodenheimer T: Uneasy alliance- clinical investigators and the pharmaceutical industry. N Engl J Med 2000; 342: 1539–1544

    Article  CAS  PubMed  Google Scholar 

  3. Angell M: Is academic medicine for sale? N Engl J Med 2000; 342: 1516–1518

    Article  CAS  PubMed  Google Scholar 

  4. Relman A, Angell M: America’s other drug problem. The New Republic, 12/16/02:27-41

  5. Public Citizen’s Congress Watch. 2002 Drug Industry Profits. Public Citizen, Washington, D.C. 2003

  6. IMS Health Integrated Promotional Services and CMR, 2002 cited in Canadian Medical Association Journal 2003;169: 699

    Google Scholar 

  7. Kessler D, Rose J, Temple R, et al: Therapeutic class wars-drug promotion in a competitive marketplace. N Engl J Med 1994; 331: 1350–1353

    Article  CAS  PubMed  Google Scholar 

  8. IMS World Pharmaceutical Market Summary http://open.imshealth.com 11/2003

  9. Profiting from Pain: Where Prescription Drug Dollars Go Families USA Publication No. 02_105 http://www.familiesusa.org 7/17/2002

  10. Wolfe SM: Why do American drug companies spend more than $12 billion a year pushing drugs? Is it education or promotion? J Gen Intern Med 1996; 11: 637–639

    Article  CAS  PubMed  Google Scholar 

  11. Pharmaceutical Research and Manufacturers of America, Pharmaceutical Industry Profile, 2001, Wash: PhRMA, 2001, Appendix: Detailed Results from the Annual Survey, Table 18

  12. Relman A: Separating continuing medical education from pharmaceutical marketing. JAMA 2001; 285: 2009–2014

    Article  CAS  PubMed  Google Scholar 

  13. Public Citizen. Medical Education Services Suppliers: A threat to physician education. http://www.citizen.org/hrg/PUBLICATIONS/1530report.htm 7/19/2000

  14. Elliott C: Pharma goes to the laundry: public relations and the business of medical education. Hastings Center Rep 2004; 34: 18–23

    Article  Google Scholar 

  15. Peterson M: Madison Ave. has growing role in the business of drug research. The New York Times, 11/22/02 pp A1, C4

  16. Avorn J, Chen M, Hartley R: Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982; 73: 4–8

    Article  CAS  PubMed  Google Scholar 

  17. Prosser H, Almonda S, Walley T: Influence on GPs’ decision to prescribe new drugs-the importance of who says what. Fam Pract 2003; 20: 61–68

    Article  PubMed  Google Scholar 

  18. Bowman M, Pearle D: Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Cont Educ in Health Prof 1988; 8: 13–20

    Article  CAS  Google Scholar 

  19. Orlowski J, Wateska L: The effects of pharmaceutical firm enticements on physician prescribing patterns. there’s no such thing as a free lunch. Chest 1992; 102: 270–273

    Article  CAS  PubMed  Google Scholar 

  20. Chren M, Landefeld S: Physicians’ behavior and their interactions with drug companies: A controlled study of physicians who requested additions to a hospital drug formulary. JAMA 1994; 271: 684–689

    Article  CAS  PubMed  Google Scholar 

  21. Tondo L, Hennen J, Baldessarini R: Lower suicide risk with long-term lithium treatment in major affective illness: A metaanalysis. Acta Psychiatr Scand 2001; 104: 163–172

    Article  CAS  PubMed  Google Scholar 

  22. Lithium decline reflects economic, not clinical trends. Clinical Psychiatry News, Vol 29 #12, 12/01, pp1,9

  23. Medawar C: The antidepressant web: marketing depression and making medicines work. Int J Risk & Safety in Med 1997; 10: 75–126

    CAS  Google Scholar 

  24. Rosencheck R, Perlick D, Bingham S, et al: Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia. A randomised controlled trial. JAMA 2003; 290: 2693–2702

    Article  Google Scholar 

  25. Healy D: Manufacturing Consensus, in Greenslit N (Ed.), Pharmaceutical Cultures: Marketing Drugs and Changing Lives in the U.S., Rutgers University Press (in press)

  26. Wilkes M, Doblin B, Shapiro M: Pharmaceutical advertisements in leading medical journals: expert’s assessments. Ann Intern Med 1992; 116: 912–919

    Article  CAS  PubMed  Google Scholar 

  27. Loke T, Koh F, Ward J: Pharmaceutical advertisement claims in australian medical publications. Is evidence accessible, compelling and communicated comprehensively? Med J Aust 2002; 177: 291–293

    PubMed  Google Scholar 

  28. Stryer D, Bero L: Characteristics of materials distributed by drug companies. J Gen Int Med 1996; 11: 575–583

    Article  CAS  Google Scholar 

  29. Ziegler M, Lew P, Singer B: The accuracy of drug information from pharmaceutical sales representatives. JAMA 1995: 273; 1296–128

    Article  CAS  PubMed  Google Scholar 

  30. Lexchin J: What information do physicians receive from pharmaceutical representatives? Can Fam Physician 1997; 43: 941–945

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Bowman M: The impact of drug company funding on the content of continuing medical education. Mobius 1986; 1: 133–136

    Google Scholar 

  32. Jackson T: Are you being duped? How drug companies use opinion leaders. BMJ 2001; 322: 1312

    Article  Google Scholar 

  33. Kjaergard LL, Als-Nielson B: Association between competing interests and authors’ conclusions: epidemiological study of randomised clinical trials published in the. BMJ BMJcom 2002; 325: 249–253

    Article  Google Scholar 

  34. Davidson RA: Source of funding and outcome of clinical trials. J Gen Intern Med 1986; 1: 155–158

    Article  CAS  PubMed  Google Scholar 

  35. Lexchin J, Bero L, Djulbegovic B, et al: Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003; 326: 1167–1173

    Article  PubMed  Google Scholar 

  36. Bekelman J, Li Y, Gross C: Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 2003; 289: 454–465

    Article  PubMed  Google Scholar 

  37. Cho MK, Bero LA: The quality of drug studies published in symposium proceedings. Ann Intern Med 1996; 124: 485–489

    Article  CAS  PubMed  Google Scholar 

  38. Bero L, Rennie D: Influences on the quality of published drug studies. Int J Technology Assessment in Health Care 1996; 12: 209–237

    Article  CAS  Google Scholar 

  39. Massie B, Rothenberg D: Publication of sponsored symposiums in medical journals. N Engl J Med 1993; 328: 1196–117

    Article  CAS  PubMed  Google Scholar 

  40. Morgan S, Barer M, Evans R: Health economists meet the fourth tempter: drug dependency and scientific discourse. Health Econ 2000; 9: 659–667

    Article  CAS  PubMed  Google Scholar 

  41. Freemantle N, Mason L, Young P: Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs: meta-regression analysis. Br J Psychiatr 2000; 177: 292–302

    Article  CAS  Google Scholar 

  42. Melander H, Ahlqvist-Rastad J, Meijer G, et al: Evidence b(i)ased medicine-selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003;326 1171–9

    Article  PubMed  Google Scholar 

  43. Safer D: Design and reporting modifications in industry-sponsored comparative psychopharmacology trials. J Nerv Ment Dis 2002; 190: 583–592

    Article  PubMed  Google Scholar 

  44. Schulman K, Seils M, Timbie J, et al: A national survey of provisions in clinical trial agreements between medical schools and industry sponsors. N Engl J Med 2002; 347: 1335–1341

    Article  PubMed  Google Scholar 

  45. Flanagan A, Carey L, Fontanarosa P, et al: Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA 1998; 280: 222–224

    Article  Google Scholar 

  46. Rennie D, Flanagan A: Authorship! authorship! guests, ghosts, grafters, and the two-sided coin. JAMA 1994; 271: 469–471

    Article  CAS  PubMed  Google Scholar 

  47. Healy D, Cattell D: Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatr 2003; 183: 22–27

    Article  Google Scholar 

  48. Choudhry N, Stelfox H, Detsky A: Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002; 287: 612–617

    Article  PubMed  Google Scholar 

  49. Lo B, Wolf L, Berkeley J: Conflict-of-interest policies for investigators in clinical trials. N Engl J Med 2000; 343: 1616–1620

    Article  CAS  PubMed  Google Scholar 

  50. Van McCrary S, Anderson C, Jakovljevic J, et al: A national survey of policies on disclosure of conflicts of interest in biomedical research. N Engl J Med 2000; 343: 1621–165

    Article  CAS  PubMed  Google Scholar 

  51. Whittington C, Kendall T, Fonagy P, et al: Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. The Lancet 2004; 363: 1341–1345

    Article  CAS  Google Scholar 

  52. Sandberg WS: The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or produces. Acad Med 1997; 72: 916–918

    Article  CAS  PubMed  Google Scholar 

  53. Wazana A: Physicians and the pharmaceutical industry. Is a gift ever just a gift? JAMA 2000; 283: 373–380

    Article  CAS  PubMed  Google Scholar 

  54. Monaghan M, Galt K, Turner P, et al: Student understanding of the relationship between the health professions and the pharmaceutical industry. Teaching and Learning in Med 2003; 15: 14–20

    Article  Google Scholar 

  55. Steinman M, Shlipak M, McPhee S: Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical sales representatives. Am J Med 2001; 110: 551–557

    Article  CAS  PubMed  Google Scholar 

  56. Hodges B: Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks. Can Med Assoc J 1995; 153: 553–559

    CAS  Google Scholar 

  57. Bellin M, McCarthy S, Drevlow L, et al: Medical students’ exposure to pharmaceutical industry marketing: A survey at one U.S. medical school. Acad Med 2004; 79: 1041–1045

    Article  PubMed  Google Scholar 

  58. Keim S, Sanders A, Witzke D, et al: Beliefs and practices of emergency medicine faculty and residents regarding professional interactions with the biomedical industry. Ann Emerg Med 1993; 22: 1576–1581

    Article  CAS  PubMed  Google Scholar 

  59. McKinney W, Schiedermayer D, Lurie N, et al: Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA 1990; 264: 1693–167

    Article  CAS  PubMed  Google Scholar 

  60. Palmisano P, Edelstein J: Teaching drug promotion abuses to health profession students. J Med Educ 1980; 55: 453–455

    CAS  PubMed  Google Scholar 

  61. American Medical Student Association’s PharmFree Medical Student Pledge (www.amsa.org/prof/pledge.cfm) Jan 22, 2001

  62. Lichstein P, Turner R, O’Brien K: Impact of pharmaceutical company representatives on internal medicine residency programs. Arch Intern Med 1992; 152: 1009–1013

    Article  CAS  PubMed  Google Scholar 

  63. Ludmerer K: Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford University Press 1999

    Google Scholar 

  64. Brodkey A, Sierles F, Spertus I, et al: Clerkship directors’ perceptions of the effects of managed care on medical students’ education. Acad Med 2002; 77: 1112–1120

    Article  PubMed  Google Scholar 

  65. Relman A: Why Johnny Can’t Operate: The Collapse of Medical Education in America. The New Republic, 10/2/00:42

  66. Chren M, Landefeld C: Doctors, drug companies, and gifts. JAMA 1989; 262: 3448–3451

    Article  CAS  PubMed  Google Scholar 

  67. Rogers W, Mansfield P, Braunack-Mayer A, et al: The ethics of pharmaceutical industry relationships with medical students. Med J Australia 2004; 180: 411–414

    PubMed  Google Scholar 

  68. Caudill T, Johnson M, Rich E, et al: Physicians, pharmaceutical sales representatives and the cost of prescribing. Arch Fam Med 1996; 5: 201–206

    Article  CAS  PubMed  Google Scholar 

  69. Haayer F: Rational prescribing and sources of information. Soc Sci Med 1982; 16: 2017–2023

    Article  CAS  PubMed  Google Scholar 

  70. Watkins C, Harvey I, Carthy P, et al: Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care 2003; 12: 29–34

    Article  CAS  PubMed  Google Scholar 

  71. Caamanol F, Figueirasl A, Gestal-Oterol J: Influence of commercial information on prescription quantity in primary care. The Eur J Public Health 2002; 12: 187–191

    Article  Google Scholar 

  72. Galt K, Rich E, Kralewski J: Group practice strategies to manage pharmaceutical cost in an HMO network. Am J Managed Care 2001; 7: 1081–1090

    CAS  Google Scholar 

  73. Lasser K, Allen P, Woolhandler S, et al: Timing of new black box warnings and withdrawals for prescription medications. JAMA 2002; 287: 2215–2220

    Article  PubMed  Google Scholar 

  74. Murray T, Campbell I: Finance, not learning needs, makes general practitioners attend courses: A database survey. Br Med J 1997; 315: 353

    Article  CAS  Google Scholar 

  75. Baird P: Funding medical and health related research in the public interest. Can Med Assoc J 1996; 155: 299–301

    CAS  Google Scholar 

  76. Tallon D, Chard J, Dieppe P: Relation between agendas of the research community and the research consumer. Lancet 2000; 355: 2037–2040

    Article  CAS  PubMed  Google Scholar 

  77. Rothman D: Medical professionalism-focusing on the real issues. N Engl J Med 2000; 342: 1284–126

    Article  CAS  PubMed  Google Scholar 

  78. Nathan D, Weatherall D: Academia and industry: lessons from the unfortunate events in toronto. The Lancet 1999; 353: 771–772

    Article  CAS  Google Scholar 

  79. Bitter Pill. The Guardian, 5/7/01

  80. The Center for Science in the Public Interest maintains a searchable database on the financial ties of nonprofit groups and scientists to corporate sources at: http://cspinet.org/integrity/nonprofits/.

  81. Blake RL, Early EK: Patients’ attitudes about gifts to physicians from pharmaceutical companies. J Am Board Fam Pract 1995; 8: 457–464

    PubMed  Google Scholar 

  82. Gibbons R, Landry F, Blouch D, et al: A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts. J Gen Intern Med 1998; 13: 151–154

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  83. Mainous A, Hueston W, Rich E: Patient perceptions of physician acceptance of gifts from the pharmaceutical industry. Arch Fam Med 1995; 4: 335–339

    Article  PubMed  Google Scholar 

  84. Arthur Andersens of Medicine. Washington Post, 4/29/02, p. A21

  85. Moynihan R, Health I, Henry D: Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324: 886–891

    Article  PubMed  Google Scholar 

  86. No Free Golf. Time Online Edition http://www.time.com/time/insidebiz/article/. accessed 11/5/02

  87. Hospital, Drug Firm Relations Probed. Boston Globe, Business Section, p. A1, 6/29/03

  88. Accreditation Council of Graduate Medical Education. Principles to Guide the Relationship between Graduate Medical Education and Industry. Washington, D.C: 9/10/02

  89. Wazana A, Primeau F: Ethical considerations in the relationship between physicians and the pharmaceutical industry. Psychiatr Clin N Am 2002; 25: 647–663

    Article  Google Scholar 

  90. Self D, Baldwin D. Moral reasoning in medicine. In: Rest JR, Narvaez D, Eds. Moral Development in the Professions: Psychology and Applied Ethics. Hillsdale, N.J: Lawrence Erlbaum Associates;1994: 147–162

    Google Scholar 

  91. Wilkes M, Hoffman J: An innovative approach to educating medical students about pharmaceutical promotion. Acad Med 2001; 76: 1271–1277

    Article  CAS  PubMed  Google Scholar 

  92. Hopper J, Speece M, Musial J: Effects of an educational intervention on residents’ knowledge and attitudes toward interactions with pharmaceutical representatives. J Gen Intern Med 1997; 12: 639–642

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  93. Shear N, Black F, Lexchin J: Examining the physician-detailer interaction. Can J Pharmacol 1996; 3: 175–179

    Google Scholar 

  94. Vinson DC, et al: Medical students’ attitudes toward pharmaceutical marketing: possibilities for change. Fam Med 1993; 25: 31–33

    CAS  PubMed  Google Scholar 

  95. Shaugnessy A, Slawson D, Bennett J: Teaching information mastery: evaluating information provided by pharmaceutical representatives. Fam Med 1995; 27: 581–585

    Google Scholar 

  96. Agrawal S, Saluja I, Kaczorowski J: A prospective before-and-after trial of an educational intervention about pharmaceutical marketing. Acad Med 2004; 79: 1046–1050

    Article  PubMed  Google Scholar 

  97. Education Council, Residency Training Programme in Internal Medicine, Dept. of Medicine, McMaster University, Hamilton, Ont. Development of residency program guidelines for interaction with the pharmaceutical industry. Can Med Assoc J: 1993; 149: 405–408

    Google Scholar 

  98. Brotzman G, Mark D: Policy recommendations for pharmaceutical representative-resident interactions. Fam Med 1992; 24: 431–432

    CAS  PubMed  Google Scholar 

  99. Wazana A, Granich A, Primeau F, et al: Using the literature in developing mcgill’s guidelines for interactions between residents and the pharmaceutical industry. Acad Med 2004; 79: 1033–1040

    Article  PubMed  Google Scholar 

  100. Brotzman G, Mark D: The effect on resident attitudes of regulatory policies regarding pharmaceutical representative activities. J Gen Intern Med 1993; 8: 130–134

    Article  CAS  PubMed  Google Scholar 

  101. McCormick B, Tomlinson G, Brill-Edwards P, et al: Effect of restricting contact between pharmaceutical company representatives and internal medicine residents on posttraining attitudes and behavior. JAMA 2001; 286: 1994–199

    Article  CAS  PubMed  Google Scholar 

  102. Wolfsthal S, Beasley B, Kopelman R, et al: Benchmarks of support in internal medicine residency training programs. Acad Med 2002; 77: 50–56

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pennsylvania Medical School, Philadelphia, Pennsylvania, USA

    Amy C. Brodkey M.D. (Clinical Associate Professor of Psychiatry)

Authors
  1. Amy C. Brodkey M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy C. Brodkey M.D..

Additional information

The author thanks Maureen Gibney, Psy. D., Joel Lexchin, M.D., and Frederick Sierles, M.D. for their helpful editorial comments.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brodkey, A.C. The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem. Acad Psychiatry 29, 222–229 (2005). https://doi.org/10.1176/appi.ap.29.2.222

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1176/appi.ap.29.2.222

Keywords

Search

Navigation