Physicians and the pharmaceutical industry: is a gift ever just a gift?

CONTEXT Controversy exists over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend a large sum of money each year promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and symposia. OBJECTIVE To identify the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians. DATA SOURCES A MEDLINE search was conducted for English-language articles published from 1994 to present, with review of reference lists from retrieved articles; in addition, an Internet database was searched and 5 key informants were interviewed. STUDY SELECTION A total of 538 studies that provided data on any of the study questions were targeted for retrieval, 29 of which were included in the analysis. DATA EXTRACTION Data were extracted by 1 author. Articles using an analytic design were considered to be of higher methodological quality. DATA SYNTHESIS Physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about 4 times per month. Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs. Attending sponsored CME 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 nonrational prescribing. CONCLUSION The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.