Monday, August 20, 2007

Some Discouraging News about Training Pharmacy Residents

Previous studies on what happens when you train medical residents about how to interact with drug company detailers ("reps") have been somewhat mixed and not all that encouraging. For one thing, you do not get residents who turn down opportunities to take stuff from the reps. But at least some studies show that residents can become more skeptical about the marketing messages received from the industry as a result of such training.

A recent study looking at pharmacy residents is discouraging even on this count.

Ashker and Burkiewicz reported on a web-based survey of 496 pharmacy residents (estimated to be about a third of potential responders). One-quarter of the residents who responded had received some sort of training regarding interactions with industry, and 60 percent said their institutions had policies regarding such interactions--though over half of that subset reported that the policies did not change their interactions.

The group, by overwhelming margins, viewed as appropriate education gifts, free samples, and attendance at dinners and meals. They balked only at "noneducational" gifts which 69 percent viewed as somewhat or very inappropriate.

Interestingly, residents at institutions that had policies, or that had received training, were less likely to believe that they or their peers were influenced by industry marketing. They did, however, receive fewer gifts (as self-reported) and were more likely to view noneducational gifts as inappropriate.

There are a number of limitations for this survey and its methods, but if we take the results at face value, it certainly is not very reassuring that educating residents (in this case, pharmacy residents, who if anything ought to be more skeptical about the industry's message than medical residents) produces the changes in behavior that I would see as desirable. I would argue that this is one more bit of evidence that it is vain to imagine that the status quo in interactions between medicine and the industry is a given, and so the best we can do is educate our trainees to act more appropriately in this environment. The only effective activity is something that changes the status quo.

Ashker S, Burkiewicz JS. Pharmacy residents' attitudes toward pharmaceutical industry promotion. Am J Health-Syst Pharm 64:1724-31, August 15, 2007

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