A Sucker Born Every Minute. Or Was That a Doctor?

A recently-published survey of almost 600 attending (academic) physicians and residents (trainees) showed that the recent increased emphasis on conflict of interest by the profession, as well as press reports about the horrendously dishonest marketing practices used by the Pharmaceutical Companies (PhARMA) in recent years, have apparently not changed the generally positive attitudes toward drug marketing activities held by the majority of physicians. 25% of the study sample even had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.

Academic doctors may be a biased sample, since so many of them have financial ties to pharmaceutical companies or have pharmaceutical companies financing their research (which is necessary for them to do in order get tenure). However, in my experience, most other doctors have the same attitudes.

Some of the findings in this particular study were rather trivial. I personally do not think that giving free samples of new medications provided by pharmaceutical representatives to patients, or talking to drug reps about new medications (for which the industry has the most information available), necessarily turns physicians into corrupt robots, although surely these activities have that effect on some doctors.

However, some of the study findings were alarming. Most of the sample felt that grand rounds (academic presentations given in medical schools that are attended by a whole department) that are sponsored by pharmaceutical companies are instructive (80.5%) despite the fact that 68% felt that the talks were biased in favor of the sponsor's product. In my experience, these sponsored lectures used to me more academic, but in recent years they have degenerated into extended commercials for a company’s product.

It was also interesting that only 35.6% of the study sample admitted that accepting lunches or gifts influences their own prescribing, but 52.2% said that doing so influences colleagues' prescribing. In other words, many doctors think they are immune themselves, but that other are not. I have heard other numbers bandied about in talks that indicate that even a smaller percentage than this of doctors think they are influenced, while a greater percentage thinks that other doctors are. Even in this study, about three-quarters (72.7%) of the doctors surveyed believe company marketing does not influence their own prescribing at all!

A pro-PhARMA blog called Policy in Medicine, which interestingly posted and then deleted a brief comment I made about the dishonest marketing techniques that were described in detail in US Justice Department memos in cases against several drug manufacturers, had a very interesting spin on these results (http://www.policymed.com/2010/06/physician-across-specialties-value-their-relationships-with-industry.html). Instead of being concerned that doctors were being induced to prescribe drugs which might not always be in their patient’s interests, they were concerned that doctors might be cut off from a valuable source of information about new drugs.

They exclaimed, “These positive results demonstrate that relationships with industry, which ‘nearly all physicians maintain,’ are important and valued by doctors. The belief that such relationships need greater awareness because of their prevalence and potential for conflict of interest is accordingly misplaced, especially since numerous recommendations from individuals, organizations and companies to improve transparency and independent regulation already exist. While the authors [of the survey] believe that ‘the effectiveness of these policies is uncertain,’ their results clearly show that whatever potential risk there may be, the benefits of such relationships for physicians far outweigh them...

...Accordingly, in attempting to bring negative attention to such relationships, the authors claim that ‘there is widespread public concern that financial relationships between physicians and industry lead to conflicts of interest.’ Such a claim is unsubstantiated considering the authors acknowledge that “evidence of physician-industry marketing relationships resulting in patient harm is inconclusive.”

Inconclusive!! Tell that to the people who had heart attacks and strokes after being prescribed Avandia when cheaper and safer drugs were available (FDA epidemiologist David Graham’s study showed that patients taking Avandia had a 27% increased risk of stroke, 25% higher chance of developing heart failure and a 14% increased risk of death over patients taking the drug Actos) . Tell that to the patients with bipolar mania who were given Zyprexa instead of lithium and developed diabetes.

Another of Policies in Medicine’s conclusions: “The results of this study show precisely how important they [relationships with industry] are to physicians and their training.” Really? I would say that what their results really show is that an awful lot doctors are not aware of how much they are being misled and influenced by people whose only concern is profit and not patients.

Even the pro-PhARMA site did note in passing:

“Many participants found large gifts unacceptable and, like participants in previous surveys, believed that other physicians were more likely to be influenced by gifts and food from industry than they were.” And…

“Participants had overall positive attitudes toward marketing-related interactions with the pharmaceutical or device industries, with most agreeing that industry educational materials and industry funding of education are useful, although 68.0% perceived bias in sponsored lectures.” And…

“…physicians can readily access independent information about drugs through journal articles and studies.”

Of course, there was no mention on the site that the journal articles may also reek with drug company bias – a far more important marketing tactic than the pen and the pizza that pro-PhARMA doctors like to get indignant about (“To think that my prescribing could be bought so cheaply!”)

If these physicians had not noticed, the drug companies have not made too much of a stink about having to get rid of the “small gifts,” nor for that matter about the new and stronger rules regarding disclosure when academic psychiatrists are being paid bundles by drug companies for giving talks and writing articles in throw-away journals – journals that all doctors have mailed to them free of charge! The companies have readily agreed to gift bans because, while they are effective in inducing doctors to prescribe their drugs to some extent, this practice is actually the least important marketing tool they have. And hardly any doctors really pay that much attention to financial disclosures.

The pro-PhARMA site also stated, based on another published study, that prescribers “are able to effectively manage PR interactions such that their own prescribing is not adversely impacted.” As a result, the study offered a parallel conclusion that “providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs.”

Well, maybe if you only looked at the pen and the pizza? Maybe not even that.

Policy in Medicine’s final conclusions: “Clearly then, physician attitudes are in fact aligned with those of the public because patients are living longer and healthier lives, physicians are receiving better training and information, and medicine is continuing to advance. These results show that by working with industry, physicians are being viewed as part of the solution, and as such, physicians must make it known that collaboration is in the best interests of the public.”

Whether collaboration is important depends strongly on how the collaboration proceeds and how it is regulated. Interested readers can read more about dishonest marketing practices in my earlier posts Pfizer Fraudulent Marketing Techniques (March 17, 2010) and The Zyprexa Documents (March 22).