Monday, June 28, 2010

Survey: Most Docs Still Accepting of Industry Goodies

A survey recently published in Archives of Surgery (subscription required) suggests that at least as recently as 2008, "pharmascold" propaganda had had very little impact on physicians' attitudes towards receiving gifts from Pharma.

Dr. Deborah Korenstein and colleagues from Mt. Sinai in New York set out to do a survey that looked at various specialties and that also compared trainees (both med students and residents) with attending physicians. They also explicitly asked about both the pharmaceutical and the device industries, whereas most previous surveys had focused solely upon the former. As a convenience sample they used departments in Mt. Sinai-affiliated hospitals, tilting the total sample toward a more academic environment. They achieved a 67% response rate.

Overall they found favorable attitudes toward interacting with drug and device companies and taking what they offered. Similar to previous surveys, they found that physicians were more leery of the more expensive gifts, more accepting of gifts that seemed explicitly related to patient care, and convinced that their colleagues were easily swayed by gifts much more than they themselves were.

What might be viewed as new findings included a generally higher level of acceptance among the trainees, despite the authors' hypothesis that the younger generation might have been more swayed by recent anti-Pharma publications and guidelines. Physicians familiar with the strict guidelines limiting Pharma gifts and contacts also expressed more critical attitudes, suggesting that these guidelines do exert some influence. Finally, the major specialty-related difference was a generally higher level of acceptance of gifts among all surgical specialties and a lower level among pediatricians.

It's worth noting that this survey was conducted in 2008, before the inauguration of the voluntary PhRMA code of conduct banning a number of gift items in January 2009. One would be curious as to how numbers derived after that major policy change would compare. Also, given the biased sample which would seem to favor a more academic type of environment, it seems disappointing (from the pharmascold pespective) that attitudes toward acceptance of gifts were so favorable; one would assume these attitudes would have been even more favorable if measured among regular community practitioners.

Korenstein D, Keyhani S, Ross JS. Physician attitudes toward industry: a view across the specialties. Archives of Surgery 145:570-577, June 2010.


Michael Kirsch, M.D. said...

Howard, I suspect that the era of Pharma dispensing largesse onto physicians has largely passed. Our practice gets some free vittles for us and the staff about twice monthly. I hope that this has not corrupted us. Incidentally, when a pharm rep is in our office, I rarely can remember which product is attached to them, which means he isn't doing his job, or my memory is more of a sieve than I feared.

Howard Brody said...

Michael-- thanks as always for writing. First, I aprpeciate the updates from the trenches as to what is happening since PhRMA's code went into effect. The reports I hear are like yours--the "reminder" items, mugs, pens, etc. have mostly disappeared, but the food remains. It is worth noting however that I know as yet of no formal studies documenting the results of the PhRMA policy.

Next, what about your experience? The rep does not get paid a bonus if you remember his name or what drug he peddles. He only gets paid a bonus if you prescribe more of his drug. If he keeps coming and keeps bringing food, that's pretty good evidence that his secret profile of you shows that you're a reliable prescriber for him. Nothing personal, just business.

Michael Kirsch, M.D. said...

Howard, I am very pleased to be a visitor to your fine blog, and will continue to 'drop in'. Regarding Pharma's influence in the office, at least in my experience, it is a shadow of what it was 10 years ago. I think the biggest obstacle they face is the formulary. We have little choice in which drugs to prescribe. The Nexium guy may have just fed the staff, the the formulary mandates Prevacid. If you have a chance, kindly drop in on my blog, as we have some common interests, although I address (aka rant) on a broader array of medical issues.