Physicians and Drug Representatives: Exploring the Dynamics of the Relationship
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Interactions between physicians and drug representatives are common, even though research shows that physicians understand the conflict of interest between marketing and patient care. Little is known about how physicians resolve this contradiction.
To determine physicians’ techniques for managing cognitive inconsistencies within their relationships with drug representatives.
Design, Setting, and Participants
Six focus groups were conducted with 32 academic and community physicians in San Diego, Atlanta, and Chicago.
Qualitative analysis of focus group transcripts to determine physicians’ attitudes towards conflict of interest and detailing, their beliefs about the quality of information conveyed and the impact on prescribing, and their resolution of the conflict between detailers’ desire to sell product and patient care.
Physicians understood the concept of conflict of interest and applied it to relationships with detailers. However, they maintained favorable views of physician–detailer exchanges. Holding these mutually contradictory attitudes, physicians were in a position of cognitive dissonance. To resolve the dissonance, they used a variety of denials and rationalizations: They avoided thinking about the conflict of interest, they disagreed that industry relationships affected physician behavior, they denied responsibility for the problem, they enumerated techniques for remaining impartial, and they reasoned that meetings with detailers were educational and benefited patients.
Although physicians understood the concept of conflict of interest, relationships with detailers set up psychological dynamics that influenced their reasoning. Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician–detailer interactions will be effective.
Key wordsphysician behavior professionalism social science qualitative research health policy
This research was supported by the Institute on Medicine as a Profession (IMAP) and the American Board of Internal Medicine (ABIM) Foundation. The authors thank their colleagues on the ABIM–IMAP committee that explored the management of physician conflicts of interest.
Potential Financial Conflicts of Interest
- 1.Rodwin MA. Medicine, Money, and Morals: Physicians’ Conflict of Interest. Oxford: Oxford University Press; 1993.Google Scholar
- 4.Consumers Union. Requiring Drug Companies to Disclose Marketing Expenditures to Physicians. Available at http://www.consumersunion.org/campaigns/learn_more/001813indiv.html. Accessed April 21, 2006.
- 6.Lexchin J. Interactions between physicians and the pharmaceutical industry: What does the literature say? Can Med Assoc J. 1993; 149:1401–7.Google Scholar
- 7.Pear R. Drug industry is told to stop gifts to doctors. The New York Times. October 1, 2002;A1.Google Scholar
- 10.Anderson T. “Drug launches and the impact of pharmaceutical promotion on physician treatment decisions.” Report presented at Prudential Financial/ImpactRx Joint Industry Conference, Omni Berkshire Place, New York, NY, June 20, 2003. Available at http://www.impactrx.com/pdfs/Prudential_Financial_ImpactRx_Joint_Industry_Conference.pdf. Accessed August 23, 2005.
- 11.Medical Professionalism Project. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243–46.Google Scholar
- 14.Hodges B. Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns, and clerks. Can Med Assoc J. 1995;153:553–9.Google Scholar
- 15.Sergeant M, Hodgetts P, Godwin M, Walker D, McHenry P. Interactions with the pharmaceutical industry: a survey of family medicine residents in Ontario. Can Med Assoc J. 1996;155:1243–8.Google Scholar
- 21.Festinger L, Riecken H, Schachter S. When Prophecy Fails. Minneapolis, MN: Lund Press; 1956.Google Scholar
- 22.Festinger L. A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press; 1957.Google Scholar
- 23.Morgan D. Focus Groups as Qualitative Research. 2nd edition. Thousand Oaks, CA: Sage Publications; 1997.Google Scholar
- 24.American Medical Association. “Gifts to physicians from industry.” JAMA 1991;265:501.Google Scholar
- 25.Pharmaceutical Research and Manufacturers of America. “PhRMA code on interactions with healthcare professionals.” Available at http://www.phrma.org/files/PhRMA%20code.pdf. Accessed December 8, 2006.
- 26.Office of the Inspector General. Compliance program guidance for pharmaceutical manufacturers. Fed Regist. 2003;68,86:23731–43.Google Scholar
- 27.Carroll R. “Cognitive dissonance.” The Skeptic’s Dictionary: A Collection of Strange Beliefs, Amusing Deceptions, and Dangerous Delusions. Hoboken, NJ: John Wiley & Sons; 2003.Google Scholar
- 30.Hensley S. “As Drug Bill Soars, Some Doctors Get an ‘Unsales’ Pitch.” The Wall Street Journal. March 13, 2006;A1.Google Scholar
- 32.Appleby J. “Sales pitch: Drug firms use perks to push pills.” USA Today. May 16, 2001;B1.Google Scholar
- 33.California Senate Bill 1765, Chapter 927, September 2004. Available at http://www.venable.com/docs/pubs/1204.pdf. Accessed December 8, 2006.
- 34.Allen D. “Drug companies woo Vermont doctors.” The Barre Montpelier Times (Argus and Rutland Herald). May 29, 2005: A1, A6.Google Scholar
- 35.Vermont Pharmaceutical Manufacturer Gift Disclosure Law (33 V.S.A. § 2005). Available at http://www.atg.state.vt.us/display.php?smod=177. Accessed August 23, 2005.
- 36.Arnold & Porter, LLP. “Pharmaceutical Companies Face New State Marketing Disclosure Laws. Arnold & Porter Update.” Available at http://www.arnoldporter.com/pubs/files/Pharma_Marketing_Disclosure_Laws.PDF. Accessed March 17, 2006.