What doctors think about drug and device marketing

by Charles Bankhead

Increased emphasis on conflicts of interest has yet to sway physicians’ generally positive attitudes toward drug and device manufacturers’ marketing activities, a survey of almost 600 attending physicians and trainees showed.

More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.

Surgeons, trainees, and respondents unfamiliar with institutional policies on conflict of interest tended to have more positive attitudes about gifts.

“Our finding of overall positive physician attitudes is notable in this time of increasing public concern about potential conflicts of interest, increasing regulation, and a move toward stricter guidelines for physician-industry interactions,” Deborah Korenstein, MD, of Mount Sinai School of Medicine in New York City, and colleagues wrote in conclusion.

“Our findings suggest the importance of physician education about the influence of industry, particularly for trainees and surgical specialists who may be less aware of the influence of industry and who may in fact be governed through their specialty bodies by more permissive guidelines.”

“If physician attitudes become congruent with the attitudes of the public, the medical profession may be viewed as part of the solution instead of part of what the nation at large perceives to be a problem,” the authors added.

The findings came from what the authors believe to be the first attempt to ascertain differences in physician attitudes toward drug and device industries across specialties and to clarify influences on the attitudes. The authors surveyed faculty and trainee physicians from all clinical departments at hospitals in the Mount Sinai consortium.

The 35-item survey consisted of seven questions related to demographics, 14 about attitudes toward industry marketing, and 14 about the appropriateness of accepting various types of gifts from industry representatives.

All told, 590 physicians and trainees completed the survey — 59.5% were men, 39% were attending physicians, and 23.7% were surgeons — for a 67% response rate.

Among the overall survey findings:

* 58.2% of respondents believe drug samples improve patient care.
* 65.6% said company materials are useful for learning about new drugs.
* 78.5% said such materials are useful for learning about new devices.
* Most felt sponsored grand rounds are instructive (80.5%) but biased in favor of the sponsor’s product (68%).
* 69.5% said accepting lunches or gifts is okay (69.5%).
* 35.6% said accepting lunches or gifts influences their own prescribing.
* 52.2% said doing so influences colleagues’ prescribing.
* About three-quarters believe company marketing does not influence their own prescribing (72.7%) or use of devices (74.4%).

A third of respondents said their institutions should prohibit trainees’ interaction with industry representatives, and 23% said institutions should prohibit attending physicians’ interaction with industry representatives.

In general, attending physicians had less favorable views about interactions with industry, as did respondents who were familiar with institutional guidelines about such interaction.

Compared with other specialties, surgeons, and Ob/Gyns had significantly more favorable views about drugs samples (P=0.05), the usefulness of company materials (P<0.001), industry support for medical school programs (P=0.007) and residency programs (P<0.001), and accepting gifts or lunches (P=0.01).

Surgeons and Ob/Gyns were significantly less likely to favor institutional restrictions on industry interaction with trainees, students, or attending physicians (P<0.001).

Limitations of the study included convenience sampling of physicians attending departmental grand rounds which might have biased the results toward more academically-oriented physicians, potential response bias toward socially-acceptable responses, and small numbers in some specialties, which restricted subgroup analyses.

Attitudes toward physician-industry interactions are not always black and white, Jo Buyske, MD, of the American Board of Surgery in Philadelphia, wrote in an invited critique. As an example, she noted that collaboration between surgeons and industry was integral to the development of laparoscopic surgery. Other types of interactions might not be so healthy for the medical profession.

“Surgeons take umbrage at the suggestion that a pen or a sandwich paid for by industry might affect their judgment,” Buyske wrote. “Yet it is hard to think that the pharmaceutical and device industry has a ‘goodwill’ budget to provide pens to needy physicians. It seems more likely that market research has shown that giving out pens increases sales or at least increases contact.

“Whatever one thinks of pens affecting judgment, this is a situation in which the benefit cannot outweigh the cost of damaging trust between physicians and their patients or physicians and the public. Like Caesar’s wife, we must be above suspicion.”

“Physician-industry interactions are not all created equal, and it is incumbent on us to be sure that policymakers and patients understand the distinctions,” Buyske concluded.

Charles Bankhead is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • http://cephalicfurrow.wordpress.com PeterW

    Now I’m usually the first one to point out conflicts of interest, which breed like rabbits in every nook of healthcare. And physician marketing is one, to be sure, But there are also benefits in the form of physician education, especially getting information out about off-label usages, which is difficult to get any other way.

    Now this is something where you have to weigh both sides and figure out the where the truth lies, and I don’t have the information to make that judgment. But it bothers me that the argument is framed in this entirely one-sided way. And it’s especially striking that the reaction to the results of the poll is intellectual bullying: “If physician attitudes become congruent with the attitudes of the public, the medical profession may be viewed as part of the solution instead of part of what the nation at large perceives to be a problem.” In other words, adopt the views of “the public” as we define them, or Something Bad would happen, and we really wouldn’t want that would we?”

    (And I’d be willing to place a pretty sizable wager on the opinions of the authors of that paper.)

  • http://fertilityfile.com IVF-MD

    The fundamental goal of most any company, including a drug company is to earn money.

    Now sometimes, this can be ethical if it involves the company people busting their butts to make an awesome product that will so greatly benefit people that they will fall over each other fighting for a chance to give money to the company. Imagine if a company came up with a product that could help a 50-year-old’s body look and function like that of a 30-year-old. Even if it cost $10000 and had to be paid for out-of-pocket, I am certain that many people would move to a smaller apartment, skip dining out and vacations, work overtime or an extra job to do whatever it takes to come up with that money. The company’s owners make a profit. The people feel great. Win/win situation. Totally ethical.

    Other times, it can be highly unethical. For example if a company makes a poor quality product that they otherwise would be unable to interest people in purchasing, let’s say some expensive vaccine that might reduce by 10% the chance of contracting a certain disease that not a lot of people really care about. In an ethical free market system, that company would be relatively punished because very few people would give them money for it and they would be forced to put their energy back to trying to make better products or else go out of business. But under our present system, there are some insidious ways to get away with trickery. For one thing, the company could spend major money on lobbyists, who then go to Washington DC and persuade the politicians to pass laws mandating the vaccine or otherwise promoting the vaccine “for public safety”. The tax money could be used to fund mass vaccinations of the population and the populace could be pressured and ordered to submit to the vaccine campaign. At the same time, the company could spend money on a massive salesforce to invade doctors’ offices and ply them with gifts and lunches to persuade the doctors to push their product. After all, the doctor has so much more power if they are basically directing the insurance company’s money and not the patient’s money. The doctor is saying to himself “Hmm, this new drug has a little bit of a benefit. And the drug rep is so nice. This evidence-based study that the drug company brought to my attention shows that it works. And it doesn’t cost the patient anything. Sure I’ll try it.” Herein lies the danger!

    So while there is nothing inherently wrong with a human being giving gifts, food or other incentives to another human being in exchange for his time and attention at listening to a sales pitch, if conditions are such where the person being offered the bribes is in a position to give other people’s money towards the unethical benefit of the gift-giver, then I feel that an outright ban should be enforced for the protection of the patient and of whoever’s money is ultimately paying for all this.

  • justin

    Let the politicians stop taking campaign gifts from companies, then we’ll talk about outlawing the free pens for doctors.

    • twicker

      Campaign contributions are protected by the Constitution:
      CRS Report: The Constitutionality of Campaign Finance Regulation: Buckley v. Valeo and Its Supreme Court Progeny

      Pharma detailing does not qualify as political speech; therefore, it has a different set of allowable restrictions. It may feel good to complain about politicians receiving gifts and doctors not receiving them, but that doesn’t change the Constitution or the Court’s rulings.

      Out of curiosity, @justin: why is it that you would like doctors to be regarded with the same degree of trust and esteem as politicians who receive lavish gifts from industry?

  • justin

    Just because the courts have ruled it so, doesn’t make it right. My comment is an oversimplification, and of course assumes that everyone believes campaign contributions are inappropriate. And just because I see the disparity between a bic pen and a $1500 contribution to a politician, doesn’t mean everyone does.

    • twicker

      Hi, Justin,

      A couple of things:
      1) While you’re correct that, as you said, “Just because the courts have ruled it so, doesn’t make it right,” it does, however, make it law. So, unless you’re suggesting we have a different system than our current Constitutional system, then it is what it is. Feel free to fight it, but, alas, thanks to the Republicans in the Senate and George W. Bush, I don’t think that the Bush/Roberts/Alito court that gave us Citizens United is going to change this any time soon.

      Re: “And just because I see the disparity between a bic pen and a $1500 contribution to a politician, doesn’t mean everyone does.”

      Two replies:
      a) From the article:

      More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery. [bolded items my own emphases - twicker]

      Last I checked, Bic pens were a bit less expensive than either the lunches pharma reps typically provided to physicians or “large gifts” — by, say, several orders of magnitude. This ain’t about Bic pens so much as it is about all the rest of that.

      b) Next, I personally would be much happier if all doctors had to publicly, for the open record, declare, individually, all gifts or “payments” by corporations/industry larger than $250, listing the amounts, date given, etc. — kinda like the politicians. I’m guessing you’d like those sunshine laws, too? Feel free to bring it up to the AMA and see how that goes for ya.

      Lastly, as I asked before — what’s the rationale behind wanting doctors to be seen as being morally equivalent to politicians — or vice versa?

      (for the record: I think all gifts to politicians, even small amounts of $25 or whatnot, should be a matter of public record, and that we should have much-stricter limits on how much anyone can give to political causes, including bans on self-funding of political campaigns [as for publicly-funded campaigns, that ain't going to happen in the US, as it requires too much tax money and that ain't going to fly]. Interestingly, that last part flies in the face of the intent of the Founding Fathers, given that they actively considered having the Senate be a non-paid position so that it could perform the duty of representing the interests of property, while the House represented the people.)

  • http://fertilityfile.com IVF-MD

    Twicker, it should be obvious to you that the risk for conflict of interest is WAY higher when a politician takes a contribution of money than when a doctor gets a pen, because the amounts are higher and the power is higher. The only difference you argue is how this sacred document champions one and not the other. Is that really so? Or is just that the supposed INTERPRETATION of it. If so, ask yourself: Who does the interpretation? Why, those nine men and women who wear robes? And who appoints THEM? Oh, the politicians. Full circle. Haha. It has to make sense to you by now that common sense transcends any arbitrary document or label. The bottom line is this. If an entity (whether a physician or a politician) receives a gift from a third party, there is a finite risk that the physician or politician just might or might not be swayed to take actions that would profit the gift-giver. That is indisputable whether you arbitrarily label one instance “Constitutional” and the other “Un-Constitutional”.

  • justin

    “b) Next, I personally would be much happier if all doctors had to publicly, for the open record, declare, individually, all gifts or “payments” by corporations/industry larger than $250, listing the amounts, date given, etc. — kinda like the politicians. I’m guessing you’d like those sunshine laws, too? Feel free to bring it up to the AMA and see how that goes for ya.”

    You seem to think I’m opposed to disclosure. You’re the one arguing for it, you bring it up.

    “… what’s the rationale behind wanting doctors to be seen as being morally equivalent to politicians…?”

    Are you suggesting that doctors are better than politicians? What makes you say that? I believe their should be equality in this issue. Politicians passing laws to prohibit a doctor getting lunch from a drug rep, then turning around and accepting contributions from a lobbyist is very hypocritical. Whether it is right or wrong is not for me to say. My problem with the issue is this: saying it’s wrong for a doctor, but okay for a politician is clearly myopic at best. At worst it’s self serving greed on the parts of politicians.

  • http://drpauldorio.com Paul Dorio

    “Are you suggesting that doctors are better than politicians?” – JUSTIN

    I guess to be fair I wouldn’t be so arrogant as to say doctors are “better” than politicians, implying lesser forms of human. But I would hope that the behaviors of doctors are typically much better than the public behaviors of politicians. I mean, do people typically sneer when they say the word “politician?” I would say yes. And do people feel the same sentiments/emotions when they use the word “doctor?” I would hope not. If they do, I need to keep working to change that mentality and I urge all my fellow physicians to do the same.

    As to the topic – I don’t think today’s world allows for sponsored lunches or gifts. But I don’t think I ever bought a rep-pushed product because he/she gave me a lunch one day. Again, it’s a matter of public perception, and it’s hard to win that game! (I’ve never gotten any gifts, btw, so that isn’t a pertinent example).