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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