Get
'em while they're young...Medical
students at risk for influence from pharmaceutical companies with
gifts, sponsored activities...
why your doctor prescribes
the drugs he does
Newswise — Third-year medical students receive on
average one gift or attend one activity sponsored by a
pharmaceutical company per week, and most believe that sponsored
educational events are likely to be biased, according to an article
in the September 7 issue of JAMA, a theme issue on medical
education.
Medical students are entering an environment with progressively
fewer boundaries between medicine and the pharmaceutical industry,
which spends $12 billion to $18 billion annually marketing to
physicians (including residents), according to background
information in the article. This includes 60 million visits annually
by pharmaceutical representatives and most of the $1.54 billion
spent annually on continuing medical education. Drug
company–physician interaction presents information favoring the
sponsor’s product and increases the likelihood of prescribing that
product. Prescribing may be inconsistent with evidence-based
guidelines and may reflect the presence of drug samples or patient
demand due to direct-to-consumer advertising, even if a drug was not
the physician’s first choice. While exposure to and attitudes about
drug company interactions among residents have been studied
extensively, relatively little is known about relationships between
drug companies and medical students.
Frederick S. Sierles, M.D., of the
Rosalind Franklin University of Medicine and Science, North Chicago,
Ill., and colleagues measured the frequency of medical students’
exposure to drug company gifts, students’ attitudes about gifts, and
correlates of these frequencies and attitudes. In 2003 the
researchers distributed a 64-item anonymous survey to 1,143
third-year students at 8 U.S. medical schools, exploring their
exposure and response to drug company interactions. The schools’
characteristics included a wide spectrum of ownership types,
National Institutes of Health funding, and geographic locations. In
2005, the researchers conducted a national survey of student affairs
deans to measure the prevalence of school-wide policies on drug
company–medical student interactions.
The overall response rate of the
surveys was 72.3 percent (826/1,143). The researchers found that
average exposure for each student was 1 gift or sponsored activity
per week. Of respondents, 93.2 percent were asked or required by a
physician to attend at least 1 sponsored lunch. Regarding attitudes,
68.8 percent believed gifts would not influence their practices and
57.7 percent believed gifts would not affect colleagues’ practices.
Of the students, 80.3 percent (553/604) believed that they were
entitled to gifts. Of 183 students who thought a gift valued at less
than $50 was inappropriate, 86.3 percent had accepted one.
Nearly 60 percent (59.6 percent)
of the students simultaneously believed that sponsored grand rounds
are educationally helpful and are likely to be biased. Students at
one school who had attended a seminar about drug company–physician
relationships were no more likely than the non-attending classmates
to show skepticism. Of the respondents, 85.6 percent did not know if
their school had a policy on these relationships. In a national
survey of student affairs deans, among the 99 who knew their policy
status, only 10.1 percent reported having school-wide policies about
these interactions.
“Our study adds to previous
literature by demonstrating experiences and attitudes among large
numbers of students at a variety of medical schools and indicating
acceptance of the value of drug company-sponsored gifts and
activities. Research should focus on evaluating methods to limit
these experiences and affect the development of these attitudes,
with a goal of ensuring that physicians’ decisions are based solely
on helping the individual patient achieve the greatest possible
benefit,” the authors conclude.
Editor’s Note: The Alliance for
Clinical Education (ACE) funded supplies (cover letter, survey form,
envelopes, postage) for the 2005 student affairs survey of deans.
There was no other external funding. For the financial disclosures
of the authors, please see the JAMA article
