"The pharmaceutical industry recognizes nursing influence on medical prescribing and identifies nurses as a marketing target," say the authors, Annemarie Jutel (Otago Polytechnic, Dunedin, New Zealand) and David Menkes (University of Auckland, Hamilton, New Zealand). "The industry has had its eye on nurses and nurse practitioners for over a decade, and is heavily invested in wooing them."

Jutel and Menkes examined the published nursing literature, to look for papers that explored the influence of drug companies upon nurses and their education. Of the 32 articles that they found, only 13 expressed or reported any serious concerns about the role of the pharmaceutical industry in influencing nursing behavior. Four articles were "clearly industry-friendly," while 14 expressed mild concern about the pharmaceutical industry, viewed the support of the industry as generally favorable, or identified both the harms and benefits of the industry's involvement in health care.

Nurses should be encouraged to re-evaluate the educational benefits of promotional information, say the authors, "which is carefully selected, prone to bias, and hardly likely to be as beneficial as many believe."

Rather simplistically, they say, many articles about the undue influence of drug companies upon nurses argue that nurses simply need to be aware of the problem, and that through such awareness nurses will be able to avoid complicity in unethical drug promotion. "This optimistic approach belies the fact that many nurses are not trained in critical appraisal, and appear to understand little of the mechanisms by which marketing strategies operate," say Jutel and Menkes.

The authors call for a three-pronged strategy to tackle drug company promotion to nurses: train nurses to understand and manage the impact of commercial activity; institute broad health care policies to identify and prevent the intrusion of external commercial interests into clinical decision making at the bedside; and conduct research that will aid nurses with the challenges of pharmaceutical promotion.

Journal citation: Jutel A, Menkes DB (2008) Soft targets: Nurses and the pharmaceutical industry. PLoS Med 5(2): e5. doi:10.1371/journal.pmed.0050005 http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050005

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