[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.142.219. Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
msJAMA
November 1, 2000

Gifts to Physicians in the Consumer Marketing Era

Author Affiliations
 

Not Available

Not Available

JAMA. 2000;284(17):2243. doi:10.1001/jama.284.17.2243-JMS1101-4-1

Many physicians are concerned about the rise of direct-to-consumer (DTC) advertising of prescription medications. However, with an annual budget of more than $5 billion supporting 59 million sales representative visits to physicians and hospitals, drug detailing remains a cornerstone of the of the pharmaceutical industry's marketing strategy.1,2 Although often viewed as different issues, concerns about consumer-directed marketing may also apply to physician-directed marketing—in particular, gifts to physicians from the pharmaceutical industry.

A majority of physicians believe that DTC advertising can have an inappropriate effect on prescribing.3 This contrasts with physicians' mixed feelings about the effect of gifts from the industry. Studies show that most physicians believe that gifts do not influence their prescribing; however, the same physicians often believe that gifts influence their colleagues.4,5 Limited data suggest that these concerns may be well founded. One study of faculty physicians found that accepting a free meal was independently associated with self-reported change in their prescribing practices.6 Another study found that physicians who requested that drugs be added to a hospital formulary were more than 10 times as likely as their colleagues to have received financial support from the companies that manufacture those drugs.7

Other physicians worry that DTC advertisements erode public trust in physicians. Patients may lose faith in their physicians when advertising messages conflict with professional advice.3 However, gifts to physicians may also undermine patient confidence in the profession. Surveys show that as many as 70% of patients believe these gifts significantly impact prescribing, and as many as two thirds believe they increase the overall cost of medications for the public.8 Furthermore, 24% of patients reported that their perception of the medical profession changed after learning about drug company gifts to physicians.9

Another concern about DTC advertisements is that patients lack the sophistication to properly interpret companies' DTC marketing claims. However, physicians who view pharmaceutical representatives as a useful source of information may face similar challenges.10,11 Studies suggest that the information provided by representatives can be biased or even incorrect, and that physicians often cannot distinguish true statements from false ones.11 Moreover, many physicians appear unaware of the extent to which commercial sources of information shape their prescribing practices.12

Physicians' awareness of the consequences of gift-giving may be limited by the lack of policies and educational programs that address this topic.5,10 Many residency training programs have no policy regulating interactions with pharmaceutical representatives.13 Policies that do exist are poorly publicized and largely unknown to residents.14 As many as 90% of physicians feel they received insufficient training about how to interact with industry representatives,15 and guidelines from organizations such as the American Medical Association are not widely known. Perhaps more importantly, drug company gifts are an accepted social norm,4,9 and colleagues may be unsupportive of physicians and medical students who challenge these practices.

Despite their concerns about the marketing of drugs to consumers, physicians are not exempt from the ethical issues raised by pharmaceutical marketing. Issues of influence, patient-physician distrust, and a susceptibility to marketing ploys apply to caregivers as well as to patients. By highlighting these parallels, the debate over DTC advertising may be a useful way for the medical profession to reflect on its own relationship with the pharmaceutical industry.

Back to top
Article Information
Funding/Support: This work was supported in part by the Veterans Affairs National Quality Scholars Fellowship Program.
References
1.
Zuger  A Fever pitch: getting doctors to prescribe is big business. New York Times. January11 1999;A113
2.
Scott-Levin Consulting, The pharmaceutical industry: more reps and more promotion fuel new launches. Press Release; 1999 June 18. Available at: http://www.scottlevin.com/news/rel_archive.cfm?rel_id = 63&prsearch. Accessed on Sept. 15, 2000.
3.
Perri III  MShinde  SBanavali  R The past, present, and future of direct-to-consumer prescription drug advertising. Clin Ther. 1999;211798- 1811Article
4.
Steinman  MAShlipak  MGMcPhee  SJ Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. [abstract]. J Gen Intern Med. 2000;15 ((suppl)) 45
5.
Hopper  JASpeece  MWMusial  JL Effects of an educational intervention on residents' knowledge and attitudes toward interactions with pharmaceutical representatives. J Gen Intern Med. 1997;12639- 642Article
6.
Lurie  NRich  ECSimpson  DE  et al.  Pharmaceutical representatives in academic medical centers: Interaction with faculty and housestaff. J Gen Intern Med. 1990;5240- 243Article
7.
Chren  MMLandefeld  CS Physicians' behavior and their interactions with drug companies: a controlled study of physicians who requested additions to a hospital drug formulary. JAMA. 1994;271684- 689Article
8.
Blake  RLEarly  EK Patients' attitudes about gifts to physicians from pharmaceutical companies. J Am Board Fam Pract 1995;8457- 464
9.
Gibbons  RVLandry  FJBlouch  DL  et al.  A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts. J Gen Intern Med. 1998;13151- 154Article
10.
Brotzman  GLMark  DH The effect on resident attitudes of regulatory policies regarding pharmaceutical representative activities. J Gen Intern Med. 1993;8130- 134Article
11.
Ziegler  MGLew  PSinger  BC The accuracy of drug information from pharmaceutical sales representatives. JAMA. 1995;2731296- 1298Article
12.
Avorn  JChen  MHartley  R Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med. 1982;734- 8Article
13.
Lichstein  PRTurner  RCO'Brien  K Impact of pharmaceutical company representatives on internal medicine residency programs: a survey of residency program directors. Arch Intern Med. 1992;1521009- 1013Article
14.
Sergeant  MDHodgetts  PGGodwin  MWalker  DMCMcHenry  P Interactions with the pharmaceutical industry: a survey of family medicine residents in Ontario. CMAJ. 1996;1551243- 1248
15.
McKinney  WPSchiedermayer  DLLurie  NSimpson  DEGoodman  JLRich  EC Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA. 1990;2641693- 1697Article
×