Medical students at risk for influence from pharmaceutical companies' marketing efforts

September 06, 2005

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.
-end-
(JAMA. 2005; 294:1034 - 1042. Available pre-embargo to the media at www.jamamedia.org.)

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.

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