Family Medicine Residencies Increasingly Eschew Pharma Influence

Alicia Ault

January 28, 2021

Two thirds of family medicine residency programs that responded to a new survey report they have eliminated pharmaceutical industry influence.

That's an increase from two previous surveys by the same researchers, Steven Brown, MD, family medicine residency director at the University of Arizona College of Medicine in Phoenix, and Adriane Fugh-Berman, MD, professor of pharmacology at Georgetown University Medical Center in Washington DC. Their latest study was published online January 14 in the Journal of the American Board of Family Medicine.

Sixty-four percent (151) of the 237 family medicine residencies that responded said they were "pharma-free," that is, they prohibit food, gifts, or drug samples, and bar industry-sponsored residency activities and interactions with medical students or residents. In comparison, 26% of family medicine residencies said they were pharma-free in 2008 and 49% reported they were in 2013. 

Moreover, in the latest survey, 81% of responding residency programs did not allow food or gifts, 86% did not allow drug samples, 84% did not allow industry to interact with students or residents, and 81% barred industry-sponsored residency activities.

"This is a trend that started probably 10 to 15 years ago," said Eric G. Campbell, PhD, professor of medicine and director of research at University of Colorado Anschutz in Aurora.

The findings are not surprising, especially for family medicine, "because it has not historically been the hotbed of this focus," Campbell told Medscape Medical News. Family physicians prescribe medications for chronic conditions, but many of these products are generics, which are not heavily marketed, said Campbell, who was not involved in the research.

But he added, "I'm surprised that 100% or near 100% aren't pharma-free."

Brown and Fugh-Berman found that university-based residency programs (40/51, 78%) were more likely to be pharma-free than community-based university-affiliated programs (90/152, 59%) or community-based nonaffiliated programs (24/46, 52%).

Program directors most commonly said that interactions with industry had declined due to institutional policies or ethical concerns. Twenty-nine programs said that faculty input had led to the decrease, while 21 mentioned a response to national legislation. Only nine program directors said interactions had declined in response to resident input.

Fewer program directors responded to Brown and Fugh-Berman's questions in the latest survey, fielded in 2019, than in the previous iterations. The 2019 survey was conducted as part of the larger Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was emailed to 628 directors. Brown and Fugh-Berman had eight questions on the CERA. Overall, 250 of 628 (39%) completed the full CERA survey and 237 (38%) answered their questions on pharmaceutical company influence. In 2013, 56% of program directors responded to Brown and Fugh-Berman's questions in the CERA; 62% responded to a 2008 free-standing survey.

When asked how these trends compare to residencies in other specialties, the authors said that no other research has looked at influence for one specialty over three different time periods.

However, Fugh-Berman notes that in a 2007 study 56% of internal medicine residencies said they accepted support from industry. The same report found that residencies with higher American Board of Internal Medicine pass rates and those with program directors who found industry support unacceptable were less likely to have industry support, said Fugh-Berman.

Curricula on Conflict Declining

Brown said he was surprised to find a decreasing number of family medicine programs taught residents about potential conflicts with industry.

In the latest survey, just 49 (21%) of the responding programs reported some type of formal instruction, compared with 84 (40%) in 2013.

The main reason given for removing the classes was that interaction with industry had declined in the past 5 years.

"My guess is that once the programs eliminated the influence they no longer felt the need to teach it in curricula," Brown said.

But removing the curricula is "fundamentally misguided," Campbell said. "It's like saying we don't have disparities in the care we provide so we're not going to teach about disparities. That doesn't make sense."

In fact, other programs indicated that because they teach residents about the potential pitfalls of industry interactions that it's acceptable to allow them, Brown said.

"We do not think that you can counteract industry influence by taking the influence, accepting the gifts, and then talking about why the gifts might be harmful," he said.

Both Brown and Campbell said they expected the pharmaceutical industry to seek other mechanisms for marketing if residencies shut them out.

"I would never underestimate the ability of the drug industry to find ways to sell their drugs," said Brown. "As a profession we should be refusing these things. It makes doctors look bad, it threatens our credibility as a trusted profession."

Brown and Fugh-Berman have reported no relevant financial relationships. Campbell has reported serving as a paid professional witness for federal, state, and local governments on cases related to opioid makers' payments to physicians.

J Am Board Fam Med. Published online January 14, 2021. Full text

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