June 23, 2010 Despite current policy trends, many clinicians continue to hold positive attitudes toward gifts from and marketing interactions with pharmaceutical and device companies, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals.
Relationships between clinicians and the pharmaceutical and medical device industry have received increased scrutiny in recent years, according to background information in the article. "We now know that nearly all physicians maintain some relationship with industry, beginning with near-universal exposure to pharmaceutical industry marketing during medical school," the authors write. These relationships range from drug samples and free food in the workplace to larger payments, such as reimbursement for educational meetings and conferences and speaking and consulting fees. "With greater awareness of the prevalence of these relationships has come greater interest in the potential conflict of interest that they pose, with recommendations from individuals and organizations to improve transparency and independent regulation."
The Mount Sinai School of Medicine consortium in the New York area has a policy that bans or limits marketing-related interactions between physicians and industry. However, the effectiveness of such policies remains uncertain, write Deborah Korenstein, M.D., of Mount Sinai School of Medicine, and colleagues, who conducted a survey of faculty and trainees in the 11 hospitals in the system in 2008.
A total of 590 clinicians and medical students completed the survey (response rate, 67 percent), of which 59.5 percent were male, 39 percent were attending physicians and 23.7 percent of the non-students were from surgical specialties. Attitudes toward industry and gifts were generally positive; 72.2 percent of participants found sponsored lunches appropriate. "Notably, many participants [74.6 percent] found large gifts unacceptable and, like participants in previous surveys, believed that other physicians were more likely to be influenced by gifts and food from industry than they were," the authors write.
Surgeons and trainees tended to have more positive attitudes toward industry than others and were more likely to deem some gifts -- including industry funding of residencies and travel expenses for attending lectures -- acceptable. Pediatricians generally held less favorable attitudes toward industry. Non-attending physicians held more positive attitudes toward receiving meals, textbooks and medication samples.
A total of 54.2 percent of the clinicians were familiar with their institution's policy toward industry interactions, and those who were unfamiliar held more positive attitudes toward such interactions. "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. However, large changes in physician attitudes are likely to require shifts in the cultural environment of medicine. 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."
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- Deborah Korenstein; Salomeh Keyhani; Joseph S. Ross. Physician Attitudes Toward Industry: A View Across the Specialties. Arch Surg, 2010; 145 (6): 570-577 [link]
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