Healthy Skepticism Library item: 20058

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Magazine

Smith P
Let's not kid ourselves: we can be influenced
Medical Observer 2006 Aug 1827

Full text:

Editor: Twice in one week the president of the AMA, Dr Mukesh Haikerwal, publicly claimed that doctors were not perversely influenced by their interactions with the pharmaceutical industry.

In an interview given to Medical Observer (‘New pharma code threatens care quality’, 4 August), commenting on the new disclosure requirements of the Australian Competition and Consumer Commission, he stated: “Doctor will not be influenced by gifts or any sort of inducements by the pharmaceutical industry…”

On the ABC radio program AM the same day, but this time in response to a published empirical study on gifts from pharmaceutical companies (McNeill et al, 2006), Dr Haikerwal again stated the belief that the medical profession was not adversely influenced by interactions with the pharmaceutical industry.

In the US, pharmaceutical companies spend more than $US12 billion ($15.8 billion) each year in promotion, and 80% of that is spent on clinicians (Stafford et al, 2003), with an estimated $8000 to $13,000 spent per year on each physician (Wazana, 2000) in support if the belief prescribing behaviour can be influenced.

Putting considerations of these facts aside, is there evidence to support the AMA’s belief to the contrary? Unfortunately, there is not. Indeed, there is a significant body of published empirical evidence which demonstrates that not only are clinicians heavily influenced by the industry, but that they are very poor judges of that influence (Dana et al, 2003).

Several studies have shown that the number of gifts received by a clinician is directly correlated with the probability that he or she will believe that contact with pharmaceutical sales representatives has no impact on their prescribing behaviour (Wazana, 2000).

It has also been demonstrated repeatedly that there is a direct relationship between the time doctors spend with pharmaceutical sales representatives and the likelihood that they will behave in industry friendly ways (Brody, 2005; Figueiras et al, 2000; Chren et al 1989).

Gibbons et al (1998) have shown that patients feel pharmaceutical company gifts are more influential and less appropriate than their doctors believe.

Belief that persists in the face of evidence to the contrary is dogma.

Modern professional practice demands something better than the AMA’s current dogmatic profession.

Dr David Smith
GP, conjoint senior lecturer,
Discipline of Ethics and Health Law,
University of Newcastle, NSW