Context Controversy exists over the fact that physicians have regular contact
with the pharmaceutical industry and its sales representatives, who spend
a large sum of money each year promoting to them by way of gifts, free meals,
travel subsidies, sponsored teachings, and symposia.
Objective To identify the extent of and attitudes toward the relationship between
physicians and the pharmaceutical industry and its representatives and its
impact on the knowledge, attitudes, and behavior of physicians.
Data Sources A MEDLINE search was conducted for English-language articles published
from 1994 to present, with review of reference lists from retrieved articles;
in addition, an Internet database was searched and 5 key informants were interviewed.
Study Selection A total of 538 studies that provided data on any of the study questions
were targeted for retrieval, 29 of which were included in the analysis.
Data Extraction Data were extracted by 1 author. Articles using an analytic design were
considered to be of higher methodological quality.
Data Synthesis Physician interactions with pharmaceutical representatives were generally
endorsed, began in medical school, and continued at a rate of about 4 times
per month. Meetings with pharmaceutical representatives were associated with
requests by physicians for adding the drugs to the hospital formulary and
changes in prescribing practice. Drug company–sponsored continuing medical
education (CME) preferentially highlighted the sponsor's drug(s) compared
with other CME programs. Attending sponsored CME events and accepting funding
for travel or lodging for educational symposia were associated with increased
prescription rates of the sponsor's medication. Attending presentations given
by pharmaceutical representative speakers was also associated with nonrational
Conclusion The present extent of physician-industry interactions appears to affect
prescribing and professional behavior and should be further addressed at the
level of policy and education.