Most Doctors Still Think It's Okay to Take Gifts From Big Pharma

Upcoming JAMA study documents that attitudes towards Big Pharma and medical device industry have changed little, in spite of recent hype to the contrary.

by Heidi Stevenson

18 June 2010

A study soon to be published in the Journal of the American Medical Association, Archives of Surgery (JAMA) documents that most physicians still take gifts from pharmaceutical and medical device manufacturers. Medical researchers at the Mt. Sinai School of Medicine surveyed a wide range of physicians practicing in medical centers associated with the school.

The results are noted in the first paragraph of the article:

We now know that nearly all physicians maintain some relationship with industry, beginning with near-universal exposure to pharmaceutical industry marketing during medical school. Most practicing physicians accept drug samples and gifts, most commonly food in the workplace, and smaller numbers of physicians accept larger payments, such as reimbursement of costs of educational meetings and conferences and speaking and consulting fees.

The Study

The authors—Deborah Korenstein, MD; Salomeh Keyhani, MD, MPH; and Joseph S. Ross, MD, MHS—approached the heads of 61 medical departments. Of those, only 35 participated. Of the 26 nonparticipants, 3 refused outright, 9 agreed but couldn't distribute the surveys at the time required, and 14 didn't even acknowledge the request.

880 surveys were distributed. 590 (67%) were returned and completed. 313 of the respondents (54.2%) were familiar with their departments' policies regarding taking gifts from pharmaceutical and medical device companies. 145 (24.6%) had worked collaboratively with pharma or device industry businesses.

Results

The surveyed physicians generally held positive views towards accepting industry gifts, and believed that accepting them was not only acceptable, but even beneficial:

• 58.2% said that samples improve patient care.
• 65.6% believe that pharmaceutical company materials are useful in learning about new drugs.
• 78.5% believe that device company materials are useful in learning about new devices.
• 71.1% believe that it's okay for companies to fund medical school programs, and 60.8% felt the same for residency programs.
• 80.5% believe that sponsored rounds are "instructive and educational", though 68.0% believe that they're biased.
• 69.5% feel it's okay to take gifts and lunches. 35.6% acknowledge it affects their prescribing and believe that it affects 52.2% of their colleagues' prescribing.
• 72.7% believe that their prescribing is unaffected by pharma ads and 74.4% believe the same of device company ads.
• Only 32.9% believe that residents and students should be prohibited from interacting with pharma and device companies, and a mere 23.2% believe that attending physicians should be so limited.

In terms of the size and type of gifts deemed acceptable, 72.2% think that a meal in a clinical setting is okay, and 35.5% think that a meal in a restaurant with no educational component is okay. However, when it was deemed educational, the percentage approving increased to 64.9% If the educational component is provided by the doctor, then 73.8% think it's all right. [Just exactly why these doctors think a Big Pharma rep is going to be interested in being educated by them wasn't discussed. -Ed.]

37.7% feel it's all right to take samples for personal use and 80.0% think that it's okay for professional use. Travel expenses to a conference are fine according to 53.4% and 10.3% believe that it's quite all right to accept a vacation from Big Pharma.

39.4% think it's just fine to be paid to attend an educational lecture by a company representative. That number goes up to 47.7% when a doctor gives the lecture. 44.2% have no problem with accepting payment to evaluate a device.

Different Specialties, Slightly Different Responses

Different specialties tended to have different responses. Surgeons generally were the most receptive to interactions with pharmaceutical and device manufacturers. The authors surmise that this may, in part, be a result of their greater dependence on the makers of devices for information. Pharmaceutical documentation is readily available from other sources. Internists tended to be the least likely to accept the idea that gifts from pharma and device makers are all right.

The differences, though, are not dramatic enough to draw significant conclusions. Generally, less than ten percentage points separated them, and in most cases, it was less than five points.

Study Limitations

The authors acknowledge certain limitations in their study. They cite the possibility that their sampling method may have oversampled academic physicians, who would likely have been more aware of industry influences. They also point out that many of the respondents may have responded in favor of more socially acceptable answers. Either of these situations could have biased the results in favor of an apparently more disapproving stance towards industry gifts than is the reality.

It should also be pointed out that a significant number of department heads refused to take part or ignored the request entirely. 17 departments didn't participate, either by outright refusal or even by simply ignoring the request. That's almost half as many as the 35 that took part in the study. Their refusal could well indicate that they see industry influence in a more positive light, but don't want a study to document it.

Between what the authors acknowledge and taking note of the large number who refused to take part, it seems likely that the percentage of doctors who believe it's okay to take gifts from Big Pharma is even higher than the study discovered.

Discussion

Clearly, the problem of corruption from Big Pharma and Big Medevices is immense—and the doctors who should be standing between patients and potentially dangerous products have very little desire to act as gatekeepers. Rather, they have chosen to accept the gifts, both subtle and blatant, that many of them acknowledge affects their practices and the majority recognize affects their compatriots' practices.

Why don't these doctors have a decent enough moral compass to know it's blatantly wrong to take gifts from corporations who want them to prescribe certain products to patients? Simply stepping back for a moment makes obvious that accepting bribes is wrong. Calling them gifts does not describe the truth of what's happening between Big Pharma/Big Medevices and physicians. They're bribes, and they're very effective.

It's difficult to accept the idea that any doctor is truly so naive as to believe that they receive those gifts for any purpose other than swaying their prescribing practices—or that they believe the gifts will continue to arrive if they don't prescribe accordingly.

It's well past time for an outside force to step in and take control. Obviously, the medical profession has lost its bearing and requires guidance.

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