Many physicians still have relationships with industry, survey suggests

"The medical profession has embraced the importance of placing patient welfare ahead of financial benefits to physicians in clinical decision making," the authors write as background information in the article. "One tenet of medical professionalism is managing conflicts of interest related to physician-industry relationships." A survey conducted in 2004 found more than 80 percent of physicians received food and beverages from industry in their workplaces, more than three-fourths received drug samples, more than one-third were reimbursed by companies for professional meetings or continuing medical education and more than one-quarter were paid for consulting, speaking or clinical trials.

Since 2004, actions at the institutional, state and national levels have been taken to limit these ties. Eric G. Campbell, Ph.D., of Massachusetts General Hospital, Boston, and colleagues conducted an updated national survey of primary care physicians and specialists in 2009. Questions were identical to those on the 2004 survey and requested information about money or gifts received from drug, device or other medically related companies. Of 2,938 eligible physicians, 1,891 completed the survey, for a response rate of 64.4 percent.

Overall, 83.8 percent of physicians reported some type of relationship with industry during the year prior to the survey. This included nearly two-thirds (63.8 percent) who received drug samples, 70.6 percent who received food and beverages, 18.3 percent who received reimbursements and 14.1 percent who received payments for professional services.

"On every measure the percentage of physicians with industry relationships was significantly lower in 2009 than in 2004," the authors write. "For example, the percentage of physicians accepting samples decreased from 78 percent in 2004 to 64 percent in 2009." In addition, the median (midpoint) number of meetings between physicians and drug representatives in an average month decreased from three in 2004 to two in 2009.

Physician specialty was associated with having industry relationships. For instance, cardiologists were more likely to have any industry relationship than psychiatrists (92.8 percent vs. 79.8 percent). Type of practice organization was also significantly associated with having industry ties. "For example, physicians in solo or two-person practices and group practices were significantly more likely than those in hospital and medical school settings to receive samples, reimbursements and gifts. However, physicians in medical schools were most likely to receive payments from industry," the authors write.

"These data clearly show that physician behavior, at least with respect to managing conflicts of interest, is mutable in a relatively short period," they conclude. "However, given that 83.8 percent of physicians have physician-industry relationships, it is clear that industry still has substantial financial links with the nation's physicians. These findings support the ongoing need for a national system of disclosure of physician-industry relationships."