This is discouraging: A new study involving 590 physicians and medical students at 11 New York and New Jersey hospitals reports that more than two-thirds of those docs and would-be docs think it’s just fine to accept gifts and payments from drug and medical-device companies.
“We found that physicians hold generally positive attitudes toward these interactions with industry,” wrote the authors of the study, which was published Monday in the journal Archives of Surgery.
Those “interactions” include receiving such freebies as drug samples, meals, educational materials (even though the physicians acknowledged the materials are often biased in favor of the sponsoring company’s products), and all-expenses paid trips to conferences and meetings (often at resort locations).
Many physicians are also quite happy to receive hefty payments for helping a company develop and/or market a drug or device. But we already knew that. As the New York Times reported earlier this year, a single drug giant, Pfizer, gave $20 million in payments to 4,500 doctors and other medical professionals during the second half of 2009 (and another $15.3 million to 250 academic medical centers and other research groups).
To be fair to the docs, although 72 percent said that industry-sponsored lunches were OK, only 25 percent thought large gifts (more than $50) were appropriate.
There was also a strong “I can’t be bought off for a measly pen or lunch” attitude among the respondents. More than half of those surveyed believed it was other physicians who were likely to be influenced by such gifts. Not them.
That’s wishful thinking, suggests a surgeon in an accompanying critique of the study: “Surgeons take umbrage at the suggestion that a pen or a sandwich paid for by industry might affect their judgment. Yet it is hard to think that the pharmaceutical and device industry has a ‘goodwill’ budget to provide pens to needy physicians. It seems more likely that market research has shown that giving out pens increases sales or at least increases contact. Whatever one thinks of pens affecting judgment, this is a situation in which the benefit cannot outweigh the cost of damaging trust between physicians and their patients or physicians and the public. Like Caesar’s wife, we must be above suspicion.”
In the next breath, however, that same doctor, Jo Buyske, a director of the American Board of Surgery, argues that it’s OK for surgeons to be paid by industry for their help with developing new products. “The baby must not be thrown out with the bathwater,” she writes. “Physician-industry interactions are not all created equal, and it is incumbent on us to be sure that policymakers and patients understand the distinction.”
OK. But it’s also incumbent that physicians understand when their treatment decisions are being influenced by their financial relationships with drug and device makers. And, of course, there should be full transparency. Patients should know, for example, if their orthopedic surgeon is a paid consultant to a company that makes a particular hip and or knee implant.
Among all the specialties surveyed for the current study, surgeons were the most likely to feel fine about accepting industry gifts. Pediatricians were the least likely to have that attitude.
The study also found that medical students eagerly embrace industry freebies — a sign, perhaps, that the message about potential conflicts of interests isn’t getting through in medical school, despite much-publicized efforts like PharmFree Days.
Participants in the study were drawn from the Mount Sinai School of Medicine consortium, which apparently has a policy that bans or limits marketing-related interactions between physicians and companies. But only 54 percent of the physicians and medical students surveyed were familiar with those restrictions.
If this study accurately reflects the prevailing attitudes of most physicians (and its authors suggest that the survey’s methodology may have underreported the number of physicians who believe gifts from industry are okay), then physicians are way behind their patients on this issue. The public has grown increasingly worried in recent years that the seemingly ubiquitous financial relationship between physicians and drug companies is compromising their care.
“[T]here is widespread public concern that financial relationships between physicians and industry lead to conflict of interest,” write the study’s authors. “… [P]hysician attitudes are not likely to align with those of the public until the culture of medicine rejects industry marketing interactions more fully.”