NEJM: Most Physicians Have Financial Ties to Industry

Last week, a study in the New England Journal of Medicine (NEJM) revealed that a whopping 94 percent of physicians in the United States have some type of relationship with the pharmaceutical industry. The authors of the study found that the level of industry contact varies with regard to doctors’ specialties, practice types, and professional activities. Their findings suggested that “industry may focus marketing efforts on physicians who are perceived as influencing the prescribing behaviors of other physicians.”

The national survey was led by Dr. Eric Campbell of the Institute for Health Policy at Massachusetts General Hospital and involved more than 3,000 doctors from six specialties: anesthesiology, cardiology, family practice, general surgery, internal medicine, and pediatrics. (About 1,600 of the doctors surveyed returned their questionnaires.) Campbell’s group concluded that “the high prevalence of physician–industry relationships underscores the need to consider their implications carefully.” The researchers also highlighted the need for “guidelines and recommendations that are specific to the context of each specialty and setting.”

The survey found that the most common relationships involved the acceptance of free food and gifts (83 percent of doctors) or free drug samples (78 percent). Perhaps more troubling, however, is the fact that more than a third of the respondents (35 percent) had been reimbursed for costs associated with professional meetings or education, and more than a quarter (28 percent) had received direct payments from industry for consulting, giving lectures, serving on advisory boards, or enrolling patients in clinical trials.

The study also noted that “cardiologists were more than twice as likely as family practitioners to receive payments for professional services.” In addition, Campbell and staff concluded that physicians in group practices were six times as likely to receive samples, three times as likely to receive gifts, and nearly four times as likely to receive payments for professional services when compared to doctors who work for hospitals, clinics, or health maintenance organizations (HMOs). Doctors with smaller Medicaid-based and uninsured patient populations were also more likely to receive industry payments. So were preceptors of physicians in training and developers of clinical guidelines, which, according to the authors, suggests that “companies may target opinion leaders for marketing.”

Meetings between doctors and industry representatives also increased significantly over the last decade. Family practitioners reported that, on average, they have 16 meetings per month with industry representatives, while internists average 10 per month, cardiologists average nine per month, and pediatricians eight per month. According to the researchers, the apparent increase in meeting rates “may reflect an intensification of industry marketing since the 1990s.”

Writing in Journal Watch, a news-summary source published by NEJM, Dr. Allan Brett said, “Physicians may disagree about the extent to which relationships with industry influence medical care, the benefit or harm resulting from that influence, and the overall ethical propriety of each type of relationship. But one thing, confirmed by this study, is clear: Physician-industry relationships are pervasive in the U.S.”

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