Healthy Skepticism Library item: 2190

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Publication type: news

Sigworth SK, Nettleman MD, Cohen GM.
Pharmaceutical Branding of Resident Physicians
JAMA 2001 09 05286:(9):1024-5
http://jama.ama-assn.org/cgi/content/full/286/9/1024-a

Keywords:
*analytic survey *letter to the editor United States physicians in training attitude toward promotion gift giving quality of prescribing relationship between physicians in training and industry sales representatives ATTITUDES REGARDING PROMOTION: PHYSICIANS IN TRAINING ETHICAL ISSUES IN PROMOTION: GIFT GIVING INFLUENCE OF PROMOTION: PRESCRIBING, DRUG USE PROMOTION AS A SOURCE OF INFORMATION: PHYSICIANS IN TRAINING PROMOTIONAL TECHNIQUES: MISCELLANEOUS

Notes:

97% of residents surveyed were carrying at least one item with a pharmaceutical insignia on it. More than 90% of residents admitted that detailing activities by pharmaceutical representatives had a partial influence when writing prescriptions.
Methodology note: The residents who were sampled were working in hospitals connected with one medical school and the results may not be generalizable.
ProCite field⁶: Analytic survey/letter to the editor
ProCite field³⁸: jama.ama-assn.org/issues/v286n9/toc.html

Full text:

To the Editor: The relationship between physicians and the pharmaceutical industry has recently gained increasing attention. For instance, some have questioned the customary practice of physicians accepting gifts in exchange for listening to a promotional message.1 There appears to be a correlation between this type of pharmaceutical detailing and physicians’ prescribing behavior,1-3 which may account for the pharmaceutical industry’s tremendous budget devoted to detailing activities.

The generosity of these representatives, in terms of these materials, is established early in medical training. During residency, the white coat often becomes the repository for these materials. It is known that the contents of the white coat can vary depending on level of training,4 but the pervasiveness of products donated by pharmaceutical companies is unknown.

Methods

We conducted a survey of primary care residents at the Medical College of Virginia Hospitals from May to June 2000. All participants were approached in their clinical setting. They first were asked to complete a questionnaire regarding their participation in pharmaceutical company–sponsored events and their perceptions of influence by pharmaceutical representatives. They then were asked to empty the contents of the pockets of their white coats. The contents were examined to determine the presence of a pharmaceutical brand name or logo. Frequency tables were constructed for each question on the survey and for items carried by residents.

Results

Of the 181 eligible residents, 164 (90.6%) responded to the survey, with 17 residents unavailable during the study period. Of the 164 residents, 161 (98%) had eaten a pharmaceutical company–sponsored meal within the past year with 162 (99%) believing that pharmaceutical representatives had accurately represented their products to at least some degree. One hundred forty-nine respondents (91%) reported that such activities partially influence their prescribing habits, with the remainder reporting no influence. Only 21 (13%) of the residents responded affirmatively to the question: “If a pharmaceutical company offered to pay you money to wear a small patch on the chest pocket of your white coat advertising their product, would you consider it?” For these residents, the median requested reimbursement from the pharmaceutical company was $100 annually (range, $0-$1.5 million).

One hundred fifty-nine (97%) of the residents were carrying at least 1 item with a pharmaceutical insignia on it. Branded items accounted for approximately 50% of the items carried by each resident, with a median number of 4. Table 1 shows the number of residents carrying a specific item and the percentage of those residents whose items were labeled with a pharmaceutical brand.

Comment

More than 90% of the residents in our study admitted that detailing activities by pharmaceutical representatives had a partial influence when writing prescriptions, a higher rate than those reported in previous studies.5, 6 This increased rate may reflect the more recent attention devoted to this issue. For instance, several studies have shown that residents who attend formal educational sessions about interactions with pharmaceutical companies are more able to critically examine the implications of those interactions.7-9 Although none of the residents that we surveyed had been exposed to such interactions, the great majority still seemed aware of the influence of pharmaceutical representatives.

The prevalence of branded items may represent the convenience associated with obtaining them. This study revealed that approximately 50% of the items that residents carry have pharmaceutical company origins, which attests to their pervasiveness. Unfortunately, the branded materials that are used in day-to-day functioning may be construed as free promotions for the pharmaceutical industry and perhaps perceived as product endorsement. Most of the residents who would refuse to wear a patch promoting a pharmaceutical product appear willing to carry branded items. It is not known what effects these products have on patients who witness their use.

Several organizations have published ethical guidelines regarding gifts from pharmaceutical companies. The American Medical Association recommends that gifts to physicians should be related to work and should be of “minimal value.“10 It appears that these branded items, which would meet these recommendations, have a substantial presence among residents.

Stephen K. Sigworth, MD, MSHA
Mary D. Nettleman, MD, MS
Department of Internal Medicine

Gail M. Cohen, MD
Department of Pediatrics
Virginia Commonwealth University
Richmond

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