Thursday, February 7, 2008

Nurses: "Soft Targets" for Pharma Marketing?

New ground is broken by Annemarie Jutel and David Menkes of New Zealand in their paper:

Given the increasingly strident and extensive debate occurring in the medical literature about physicians and pharmaceutical marketing, the authors wondered what was going on in the nursing literature. After an extensive search they identified only 32 articles, including empirical studies (only 7), editorials, comments, and opinions.

They found a number of causes for concern:
  • Nurses seem timid in criticizing industry marketing practices. A paper that finds many reasons to condemn (for instance) DTC advertising, then feels a need for "balance" and so proceeds to list all the favorable aspects of DTC.
  • When nurses write opinion pieces sharply critical of the industry, the editor of the journal often feels a need to soften the impact by printing a dismissive reply, or by appending a defense of the industry from an industry rep.
  • An undercurrent that runs through many articles seems to go roughly as follows: physicians, of course, are evil beasts, so it is no surprise that they fall prey to industry marketing blandishments. Nurses, by contrast, are ethically far superior to docs, so there is no way that they would be similarly seduced. This belief in the ethical purity of the nurse is maintained despite 1) all the data showing that physicians similarly feel immune and yet are easily swayed; 2) the absence from the nursing curriculum of any formal courses warning nurses about the dangers of marketing messages; and 3) the similar absence from the nursing curriculum of courses such as critical appraisal of the literature, biostatistics, and other material that would enhance their ability to review marketing information with proper skepticism.
  • An even more worrisome undercurrent in a few articles that says, how come docs get all the goodies; what are nurses, chopped liver? How come we don't get our fair share of the bribes? (Especially from nurse practitioners with prescribing privileges)

The concluding paragraph of the paper is worth quoting in full (cites omitted):

The pharmaceutical industry recognises nursing influence on medical prescribing and identifies nurses as a marketing target. The industry has had its eye on nurses and nurse practitioners for over a decade, and is heavily invested in wooing them. Unfortunately, its success in this area has been at the expense of the health budget, evidence-based care, and nursing integrity. All three can and must be reclaimed.

Nurses historically have many legitimate grievances against the medical profession. It would be very sad indeed if nursing allowed those grievances to blind them to the real dangers to their professional values posed by pharmaceutical marketing and "gifts."

Jutel A, Menkes DB. Soft targets: nurses and the pharmaceutical industry. PLoS Med 5(2):e5. doi:10.1371/journal.pmed.0050005

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