Here’s why we’ve organized this group and why we’re disseminating information about pharmaceutical industry interactions:

Pharmaceutical industry gifts, regardless of size, influence physician prescribing practices. (Dig Deeper)

Free samples do not provide a safety net for the uninsured; they are just another marketing tool used by the industry to influence physicians. (Dig Deeper)

Pharmaceutical educational materials and advertisements are often misleading and, at times, incorrect. (Dig Deeper)

When it comes to advertising, medical professionals are no more rational and critical than the average person, and physicians are as susceptible to targeted marketing as others.

More scrutiny is needed of pharmaceutical sponsorship of clinical investigations, especially considering the industry’s history of exaggerating positive results and suppressing negative ones.

Dig Deeper

Pharmaceutical industry gifts, regardless of size, influence physician prescribing practices.

Research examining physician thoughts about pharmaceutical gifts offers the first sign that something is amiss. While the majority of physicians feel that they are immune to the influence of receiving gifts, they are not as confident in their peers.  One study of physicians asked about the influence of pharmaceutical reps on “your prescribing practices” compared to “other physicians’ prescribing practices;” 61% felt there was no influence on their behavior, but only 16% felt the same could be said for their colleagues (Steinman Am J Med 2001). 

Regardless, both theoretical and empirical evidence reveals that physicians are influenced by pharmaceutical industry practices.  Authors focus on the gift-relationship and the self-serving bias that it can engender (Blumental NEJM 2004; Dana JAMA 2003).  Gifts, even seemingly trivial ones, create a sense of indebtedness and “impose on the recipient” an obligation to reciprocate.  “Food, flattery, and friendship” are powerful tools of persuasion, especially when combined (Katz Am J Bioth 2003).  Individuals immersed in this gift-relationship fall victim to a self-serving bias. Because they are benefiting from the exchange, they are less likely to recognize that they are being influenced by it.  One study examined the prescribing of two drugs by twenty physicians that attended a pharm-sponsored CME seminar.  The authors found that, despite physician denial before the seminar that they would be influenced, after the seminar, physicians increased their prescribing of the two medications compared to other physicians, both in time series at the institution and with the national average during the same period (Orlowski Chest 1992). 

A review of sixteen studies examining various interactions between drug companies and physicians found mostly negative outcomes resulting from these interactions (Wazana JAMA 2000).  Physicians that interacted with pharmaceutical representatives were more likely than those who did not to: request formulary additions for the company’s drug, usually at no therapeutic benefit over existing formulary medications; exhibit “awareness, preference, and rapid prescribing of new drugs;” and, prescribe fewer generic and more expensive, newer medications – often at no advantage over the generic ones.  These impacts have lead various policy leaders across the country to call for a complete ban on gift-giving from pharma to physicians (Brennan JAMA 2006).  Finally, if relationships and the gifts that come of them did not affect practice, pharmaceutical companies would not invest $19 billion each year establishing and maintaining them.

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Free samples do not provide a safety net for the uninsured; they are just another marketing tool used by the industry to influence physicians.

Despite claims by the pharmaceutical industry that free samples are a means of addressing the healthcare needs of the uninsured, evidence suggests otherwise.  Analysis of a national survey of approximately 33,000 US residents revealed that more insured patients receive samples compared to those who are uninsured for either part of or all of the year (Cutrona AJPH 2008).  When controlling for demographic variables except insurance status, the uninsured were no more likely to receive a free sample than the insured (OR=0.98, 95% CI=0.087, 1.11). 

These results add to a growing body of literature that reveal free samples do not help patients, despite being advertised as doing so.  A recent study found that patients who receive drugs samples have significantly higher out-of-pocket costs for their prescription medications than those who do not receive free samples (Alexander Med Care 2008).  Thus, sample receipt may lead to enhanced brand loyalty on the part of the patient, leading both patients and their providers to choose expensive brand name medications over comparable generic ones.  Samples also have a negative impact on physicians, as they are just like any other industry gift.  They influence residents to prescribe newer, more advertised medications and fewer over-the-counter (OTC) and less expensive medications (Adair Am J Med 2005).  The majority of samples may not even make it to patients, as surveys have revealed that the majority of physicians (Westfall JAMA 1997) and pharm reps (Tong Can Fam Physician 1993) take samples for themselves and/or their friends and family.  Additionally, samples bypass a safety system against adverse effects and drug interactions (Mackinnon Am J Health Syst Pharm 2004), and they do not appear to help patients manage their medication costs in the long-term (Groves J Clin Pharm Ther 2003).

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Pharmaceutical educational materials and advertisements to physicians are often misleading and, at times, incorrect.

Pharmaceutical advertisements in medical journals, graphs in those ads, materials distributed, and the information presented by pharm reps to physicians is often misleading and incorrect.  A review of pharm ads in ten medical journals (American Journal of Psychiatry, Annals of Emergency Medicine, Annals of Internal Medicine, Annals of Surgery, Hospital Practice, JAMA, NEJM, Neurology, Obstetrics and Gynecology, and Pediatrics) found 1/3 of ads did not provide any evidence to support the companies’ claims about the medications (Cooper RJ CMAJ 2005).  Additional studies examining the citations used in pharm ads to support statements found that they often failed to do so, with at least 19% to as much as 44% of the promotional statements not being supported by the reference (Keng Ann Pharmacother 1994; Villanueva Lancet 2003).  As for graphs in these ads, a study examining the same ten journals mentioned above found numeric distortion in 36% of graphs, which is prohibited by FDA regulations (Cooper J Gen Intern Med 2003).  Similar to ads in journals, materials distributed by pharm companies to physicians rarely conveyed information about important therapeutic breakthroughs, and some of them failed to comply with FDA regulations. The materials were presented as being ostensibly educational, but they often contained promotional characteristics (Stryer D J Gen Int Med 1996).  Finally, another study analyzing thirteen oral presentations by pharm reps at pharm-sponsored lucnhes found that 11% of statements made about their medications were inaccurate, always biased in favor of the promoted drug.  Only 26% of physicians in attendance recalled any false statement being made by the pharm rep (Ziegler MG JAMA 1995).

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