Ninety-four percent of physicians have relationships with pharmaceutical companies in which the companies provide them with food and beverages, medication samples, and other gifts and payments, according to a study published on Thursday in the New England Journal of Medicine, the Pittsburgh Post-Gazette reports (Fahy, Pittsburgh Post-Gazette, 4/26). For the study, Harvard Medical School researchers in late 2003 and early 2004 mailed surveys and a $20 check to a random sample of 3,167 anesthesiologists, cardiologists, family practitioners, general surgeons, internists and pediatricians (Rubin, USA Today, 4/26). More than 1,600 physicians responded to the survey. The study found:

83% of physicians received food and beverages from pharmaceutical company sales representatives;
78% received medication samples (Gellene, Los Angeles Times, 4/26);
35% received reimbursement for the cost of attendance at continuing medical education conferences sponsored by pharmaceutical companies;
28% received fees from the pharmaceutical companies for consulting, speaking engagements or enrollment of patients in clinical trials; and
7% received tickets to sports events and entertainment (Pereira, Wall Street Journal, 4/26).

The study found that family practitioners met with pharmaceutical company sales representatives "far more often" than other physicians and were the most likely to receive food, beverages and other gifts, the AP/Philadelphia Inquirer reports. However, cardiologists were more than twice as likely as family practitioners to receive fees from pharmaceutical companies, the study found. Physicians in private practices were six times more likely to receive medication samples and three times more likely to receive other gifts than those in hospitals, according to the study (Chang, AP/Philadelphia Inquirer, 4/26). The study is the first to examine the issue of gifts to physicians since the pharmaceutical industry and the American Medical Association each established voluntary guidelines in 2002. The guidelines, prompted by concerns about potential conflicts of interest, established limits on the value and the type of gifts considered acceptable. The study found that some of the gifts physicians received "clearly fell outside ethical guidelines," the Times reports (Los Angeles Times, 4/26).

Reaction
Lead study co-author Eric Campbell, an associate professor of medicine at Massachusetts General Hospital and Harvard, said, "Would you care if this person was managing your 401(k) and you found out they had financial relationships with mutual fund companies, if an umpire was calling the World Series ... would anybody care if the umpires were being paid by either of those two teams? If people would be very concerned that it was happening in a baseball game, you would be even more concerned if it was something like your health" (Japsen, Chicago Tribune, 4/26). He added, "If the companies didn't benefit from the relationships, they wouldn't be doing it" (Los Angeles Times, 4/26). Study co-author David Blumenthal, a Harvard medical professor, said, "We all know that gifts and gratuities create a subconscious sense of indebtedness, and they improve the likelihood of a physician using that particular drug company's brand of medicine." David Rothman -- president of the Institute on Medicine as a Profession, which funded the study -- said, "Unfortunately, as things stand, it's going to be up to doctors to clean up their act." However, Thomas Stossel, a Harvard medical professor not involved with the study, said, "If a physician can be influenced into prescribing certain drugs just because he had pizza with a pharmaceutical guy, then it's the fault of his training and not the drug company" (Wall Street Journal, 4/26). Ken Johnson, a senior vice president for the Pharmaceutical Research and Manufacturers of America, said, "Pharmaceutical marketing is one of several very important ways for health care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated" (Ricks, Long Island Newsday, 4/25). The study is available online.

Broadcast Coverage
Two broadcast programs reported on the study: American Public Media's "Marketplace": The segment includes comments from Campbell (Moon, "Marketplace," APM, 4/25). Audio of the segment is available online.
NBC's "Nightly News": The segment includes comments from a former pharmaceutical company sales representative and Jonathan Mohrer, a New York physician who no longer allows pharmaceutical company sales representatives into his office (Bazell, "Nightly News," NBC, 4/25). Video of the segment is available online.


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