1 in 4 Family Medicine Residencies Shun Pharma Reps, Support

March 25, 2011

March 25, 2011 — One in 4 family medicine residency programs have nothing to do with pharmaceutical companies, whether it is taking their drug samples, eating their pizza, or letting them bring in a speaker, according to a study published online yesterday in Academic Medicine.

Although most family medicine residencies allow some measure of pharmaceutical industry support, the percentage that does is decreasing, from 90% in 1992 to 74% in late 2008, when the study authors conducted their survey. They point to a similar trend among internal medicine residency programs, where pharmaceutical company inroads also are on the wane.

The rationale for fencing out the pharmaceutical industry is, of course, that sales talks, drug samples, pizza, and money may influence physicians to prescribe medications contrary to the best scientific evidence.

Dr. Adriane Fugh-Berman

"Reliable information cannot be extracted from industry marketing pitches, and seemingly collegial relationships may undermine physicians' critical evaluation of the risks and benefits of new medicines," lead author Adriane Fugh-Berman, MD, an associate professor in the departments of pharmacology and family medicine at Georgetown University, Washington, DC, and colleagues write.

At the same time, pharmaceutical companies disguise the marketing nature of their physician outreach, Dr. Fugh-Berman told Medscape Medical News.

"Huge amounts of money and resources are put toward manipulating physicians' prescribing habits while making physicians believe they are making independent decisions," said Dr. Fugh-Berman, who also is the director of PharmedOut, a group that seeks to eliminate the role played by pharmaceutical companies in medical education. "Subtlety and sophistication are the hallmarks of this promotion."

In a press release issued yesterday, the Pharmaceutical Research and Manufacturers of America (PhRMA) defended the interactions of its members with academic medical centers and physicians in training.

"Providing physicians — and medical students — with timely, accurate information about the medicines they prescribe clearly benefits patients and advances healthcare," stated PhRMA. "And importantly, biopharmaceutical research companies are careful to ensure that their relationships with both healthcare professionals and students are ethical and appropriate." (A spokesperson for PhRMA declined an interview request by Medscape Medical News and supplied the press release instead.)

The study in Academic Medicine is one more sign of strain between the pharmaceutical industry and the medical profession. In recent years, some academic medical centers and medical schools have banned pharmaceutical representatives from giving away drug samples and meals and forced them to see clinicians on an appointment-only basis.

In January 2009, PhRMA responded to increased concern about its marketing practices by instituting a tougher, voluntary code of behavior for its member companies' sales force. Representatives should no longer leave behind branded items such as pens and mugs or treat physicians to restaurant meals. However, they can still bestow educational items worth $100 or less, such as textbooks, and supply in-office meals during a presentation.

"Food Is Addictive"

To determine whether a family medicine residency was "pharma-free," Dr. Fugh-Berman and her coauthors posed 4 questions to program directors and coordinators:

  • Does the program allow gifts or food from industry?

  • Does the program accept drug samples?

  • Are industry representatives given access to residents and medical students?

  • Does the program allow any industry-sponsored activities?

A residency program had to answer "no" to all 4 questions to be considered pharma-free. In inquiring about the program's relationship to "industry," researchers sought to include not only pharmaceutical companies but also businesses that sell medical devices, biologics, and dermatologic products.

According to the study, 26.2% of programs qualified as pharma-free. However, those that were not pharma-free were not entirely pharma friendly either. Of the 460 programs surveyed, 52.1% refused samples, 48.6% banned industry food and gifts, 68.5% banned industry-sponsored residency activities, and 44% denied industry any access to students and residents at the family medicine center.

In addition, some programs that accepted industry support to some degree told researchers that they intended to impose more restrictions, or go entirely pharma-free.

The study noted several challenges for residency programs to separate themselves from the pharmaceutical industry. "Food is addictive," one respondent wrote. Another pointed out that some faculty physicians resist industry bans because they feel demeaned by the assumption that they "lack the integrity and professionalism to deal with pharma reps in a responsible way."

Even with tight restrictions in place, the authors noted, pharmaceutical representatives can still exert influence because residents are free to attend industry-sponsored events, such as an evening talk, during their free time. Dr. Fugh-Berman told Medscape Medical News that extracurricular activities include "liver rounds."

"They get together for drinks," she said.

Adriane Fugh-Berman, MD, is director of PharmedOut and serves as a paid expert witness on behalf of plaintiffs in litigation regarding pharmaceutical marketing practices. Coauthor Alicia Bell is a former project manager of PharmedOut, a project to educate physicians about inappropriate pharmaceutical company influence.

Acad Med. Published online March 24, 2011.


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