Journal of General Internal Medicine

, Volume 27, Issue 3, pp 274–279

Pharmaceutical Industry Gifts to Physicians: Patient Beliefs and Trust in Physicians and the Health Care System

Original Research



Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system.


To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system.


Cross sectional random digit dial telephone survey.


African-American and White adults in 40 large metropolitan areas.


Respondents’ beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust.


Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56–3.30) and high health care system distrust (OR 2.03, 95% CI 1.49–2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25–2.29) and high health care system distrust (OR 2.57, 95% CI 1.82–3.62).


Patients perceive physician–industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry–physician gifts could have positive effects beyond reducing influences on physician behavior.


pharmaceutical marketing conflicts of interest trust medical professionalism 


  1. 1.
    Campbell EG, Rao SR, DesRoches CM, et al. Physician Professionalism and Changes in Physician–Industry Relationships From 2004 to 2009. Arch Intern Med. 170:1820–6.Google Scholar
  2. 2.
    Wazana A. Physicians and the pharmaceutical industry—Is a gift ever just a gift? JAMA. 2000;283:373–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CMAJ. 1993;149:1401–7.PubMedGoogle Scholar
  4. 4.
    Blumenthal D. Doctors and Drug Companies. New Engl J Med. 2004;351:1885–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Brennan TA, Rothman DJ, Blank L, et al. Health industry practices that create conflicts of interest: A policy proposal for academic medical centers. JAMA. 2006;295:429–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Cain DM, Detsky AS. Everyone's a little bit biased (even physicians). JAMA. 2008;299:2893–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Brennan TA, Mello MM. Sunshine laws and the pharmaceutical industry. JAMA. 2007;297:1255–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Association of American Medical Colleges. Industry funding of medical education report of an AAMC task force. Washington, DC; 2008.Google Scholar
  9. 9.
    Coyle SL, For the Ethics and Human Rights Committee ACP-ASIM. Physician–industry relations. Part 1: individual physicians. Ann Intern Med. 2002;136:396–402.PubMedGoogle Scholar
  10. 10.
    Pearson SD, Raeke LH. Patients' trust in physicians: many theories, few measures, and little data. J Gen Intern Med. 2000;15:509–13.PubMedCrossRefGoogle Scholar
  11. 11.
    Mechanic D. The functions and limitations of trust in the provision of medical care. J Health Polit Pol Law. 1998;23:661–87.Google Scholar
  12. 12.
    Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000;51:657–68.PubMedCrossRefGoogle Scholar
  13. 13.
    Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613–39.PubMedCrossRefGoogle Scholar
  14. 14.
    Mechanic D. Changing medical organization and the erosion of trust. Milbank Q. 1996;74:171–89.PubMedCrossRefGoogle Scholar
  15. 15.
    Goold S. Money and trust: relationships between patients, physicians and health plans. J Health Polit Pol Law. 1998;23:688–95.Google Scholar
  16. 16.
    Hall MA. Arrow on Trust. J Health Polit Pol Law. 2001; 26:1131.CrossRefGoogle Scholar
  17. 17.
    Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.PubMedGoogle Scholar
  18. 18.
    Carpenter WR, Godley PA, Clark JA, et al. Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer. 2009;115:5048–59.PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson LA, Dedrick RF. Development of the Trust in Physician Scale: A measure to assess interpersonal trust in patient–physician relationships. Psychol Rep. 1990;67:1091–100.PubMedGoogle Scholar
  20. 20.
    Bickell NA, Weidmann J, Fei K, Lin JJ, Leventhal H. Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol. 2009;27:5160–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Nummela O, Sulander T, Rahkonen O, Uutela A. The effect of trust and change in trust on self-rated health: a longitudinal study among aging people. Arch Gerontol Geriatr. 2009;49:339–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med. 2006;21:292–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Gibbons R, Landry F, Blouch D, et al. A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts. J Gen Intern Med. 1998;13:151–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Mainous AG, III, Hueston WJ, Rich EC. Patient perceptions of physician acceptance of gifts from the pharmaceutical industry. Arch Fam Med. 1995;4:335–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Campbell E, Gruen R, Mountford J, Miller L, Clearly P, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med. 2007;356:1742–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Shea J, Micco E, Dean L, McMurphy SS, JS, Armstrong K. Development of a revised Health Care System Distrust scale. J Gen Intern Med. 2008;23:727–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Safran D, Kosinski M, Tarlov A, et al. The primary care assessment survey: tests of data quality and measurement performance. Med Care. 1998;36:728–39.PubMedCrossRefGoogle Scholar
  28. 28.
    Davis JAS, Tom W, Peter V. General social surveys, 1972–2008: cumulative codebook / Principal Investigator, James A. Davis; Director and Co-Principal Investigator, Tom W. Smith; Co-Principal Investigator, Peter V. Marsden. Chicago: National Opinion Research Center; 2009.Google Scholar
  29. 29.
    Standard definitions: final dispositions of case codes and outcome rates for surveys. Lenexa, Kansas: The American Association for Public Opinion Research; 2004.Google Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • David Grande
    • 1
    • 2
  • Judy A. Shea
    • 1
    • 2
  • Katrina Armstrong
    • 1
    • 2
    • 3
  1. 1.Department of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Abramson Cancer CenterUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations