THE interaction between the pharmaceutical industry and the medical profession has long been a subject of debate. Controversy exists over the large sums of money some companies spend promoting their products to doctors, often with gifts, free meals, travel subsidies and sponsored symposia. Now a study has concluded that the issue needs to be addressed both at policy level and during medical training.

The study set out to identify the extent of the relationship between physicians and the pharmaceutical industry and its representatives, and its impact on doctors' knowledge, attitudes and behaviour. A Medline search was done for Englishlanguage articles published from 1994 to January 2000, with review of reference lists from retrieved articles. In addition, an Internet database was searched and five key informants were interviewed. Twenty-nine studies published in peer reviewed journals were included in the research. Of these 16 addressed the extent of the physician-industry interaction, 16 identified the attitude of the physician towards the interaction and 16 evaluated the effect of the interaction on the practitioner. Articles using an analytic design (having a comparison group) were considered to be of higher methodological quality.

Effects on prescribing behaviour

Research showed that physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about four per month. Meetings with representatives were associated with requests by doctors to add the drugs discussed to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education preferentially highlighted the sponsor's drug(s) compared with other continuing education programmes. Attending sponsored medical education events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with non rational prescribing.

The study concludes that the present extent of physician-industry interactions appears to affect prescribing and professional behaviour. It calls on policy-makers and educators to address this complex issue and the ethical considerations raised.

Reproduced by kind permission of J. Collier

Reference

1. Wazana A. Physicians and the pharmaceutical industry. Is a gift ever just a gift? Journal of the American Medical Association 2000;283:373 - 380.