Nearly all physicians have ties to the pharmaceutical or device industries ranging from accepting drug samples to serving on a speakers' bureau, according to a survey of physicians across six specialties.
The study found that 94% of physicians surveyed reported some type of relationship with industry, most frequently receiving food in the workplace (83%); 78% also reported accepting drug samples.
Fewer physicians, about 35%, reported accepting reimbursement for admission to continuing medical education meetings or other meeting-related expenses, and 28% said they received payments for consulting, speaking, serving on an advisory board, or enrolling patients in clinical trials (N. Engl. J. Med. 2007;356;1742–50).
Physicians contacted by this news organization said that while the study raises important issues, it is not a cause for alarm since many of the industry interactions outlined in the study are essential and appropriate.
Eric G. Campbell, Ph.D., of the Institute for Health Policy at Massachusetts General Hospital-Partners Health Care System in Boston, and his colleagues surveyed 3,167 physicians working in anesthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics. Of those surveyed, 1,662 completed the questionnaire for an overall response rate of about 52%. The study was supported by a grant from the Institute on Medicine as a Profession.
The type and extent of reported interaction with representatives of the pharmaceutical and device industries varied by specialty, the researchers found. For example, cardiologists were more than twice as likely as family physicians to receive payments for professional services, such as consulting or work on clinical trials.
Family physicians held the most meetings with industry representatives, on average about 16 meetings per month, according to the study.
Practice setting also played a role in the interaction. Physicians in group practice were six times more likely to receive drug samples than were those in hospitals, clinics, or staff-model health maintenance organizations, three times as likely to receive gifts, and nearly four times as likely to receive payments for professional services.
In an interview, Dr. James King, president-elect of the American Academy of Family Physicians said, “I don't think it's a major cause for concern.”
Dr. King said he was not surprised by the survey findings, especially since it is a common practice for physicians to accept drug samples in an effort to save their patients money. Most practices are likely operating within the guidelines set out by the American Medical Association, he said. The AMA guidelines recommend that gifts should primarily have a benefit to patients and should not be of substantial value. For example, modest meals and textbooks are acceptable under the AMA guidelines, but cash payments should not be accepted.
The relationship with industry should continue to be watched and addressed, said Dr. King, who recommended that physicians review their own ethical guidelines from time to time and refuse to accept any gift that would inappropriately influence their prescribing habits.
Dr. Jack Lewin, CEO of the American College of Cardiology, called for an increase in the number of publicly funded independent reviews of drugs and devices. Increases in federal research funding would help to clarify some of the gray areas of cardiovascular care, he added.