Four out of five doctors surveyed said they let drug and device makers buy them food and drinks despite recent efforts to tighten ethics rules and avoid conflicts of interest.
The national survey also found that family doctors were more likely to meet with industry sales representatives, and that cardiologists were more likely to pocket fees than other specialists.
The study is the first to document the extent of the relationships between doctors and sales reps since 2002 when a leading industry group adopted voluntary guidelines discouraging companies from giving doctors gifts or tickets. In general, researchers found hardly anything had changed since previous studies a couple years earlier.
Consumer advocates say this is proof the new rules aren’t working.
“These findings are fairly disturbing. There appears to be no dialing back at all on these relationships,” said Merrill Goozner of the Center for Science in the Public Interest.
The survey, published in Thursday’s New England Journal of Medicine, was done by researchers from Massachusetts General Hospital, Yale University and the University of Melbourne in Australia.
Responses were anonymous. About 95 percent said they had contact with drug or device companies.
Targeting influence
The extent of the interactions varied by specialty, and sales reps tend to target doctors with the most influence. For example, cardiologists were more than twice as likely than family doctors to receive fees. Doctors in private practice were six times more likely to get free samples and three times more likely to get gifts than those at hospitals. Family doctors met with sales reps far more often than their counterparts — about 16 meetings a month.
Doctors need to “supervise themselves and set stricter standards on what is appropriate and acceptable behavior,” said one of the authors, Dr. David Blumenthal, head of the Institute for Health Policy at Massachusetts General Hospital.
The study was funded by the New York-based Institute on Medicine as a Profession. None of the authors reported conflicts of interest related to the study.
Previous studies have suggested that cozy relationships with industry can affect doctors’ prescribing patterns and judgment. But companies have defended the practice as a legitimate way to educate physicians about the latest drugs and technology.
The Pharmaceutical Research and Manufacturers of America, the leading trade group, in 2002 adopted voluntary rules limiting the value of gifts to $100 or less and banning free entertainment tickets.
‘Common knowledge’
Scott Lassman, a senior assistant general counsel with the trade group, said the study’s results were “common knowledge” and dismissed claims that companies were out to influence doctors.
“A modest meal is not going to affect the independence of the health care practitioner,” Lassman said.
Dr. Anmol S. Mahal, a gastroenterologist at a group practice in Fremont, Calif., said he often hands out free drug samples to needy patients. Mahal said he doesn’t accept other freebies.
“It’s really a service that a physician attempts to provide to their patients” with the drug samples, said Mahal, who is also the president of the California Medical Association.
Dr. Harlan Krumholz, a Yale cardiologist, favors an all-out ban on small gifts and free meals because such rewards don’t benefit patients.
“These little perks can put doctors in a difficult position,” said Krumholz, who serves on the scientific advisory board of Amgen Inc.
