Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review
Background:
The relationship between health professionals and the pharmaceutical industry
has become a source of controversy. Physicians' attitudes towards the
industry can form early in their careers, but little is known about this key
stage of development.
Methods and Findings:
We performed a systematic review reported according to PRISMA guidelines to
determine the frequency and nature of medical students' exposure to the
drug industry, as well as students' attitudes concerning pharmaceutical
policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from
the earliest available dates through May 2010, as well as bibliographies of
selected studies. We sought original studies that reported quantitative or
qualitative data about medical students' exposure to pharmaceutical
marketing, their attitudes about marketing practices, relationships with
industry, and related pharmaceutical policy issues. Studies were separated,
where possible, into those that addressed preclinical versus clinical
training, and were quality rated using a standard methodology. Thirty-two
studies met inclusion criteria. We found that 40%–100%
of medical students reported interacting with the pharmaceutical industry. A
substantial proportion of students (13%–69%) were
reported as believing that gifts from industry influence prescribing. Eight
studies reported a correlation between frequency of contact and favorable
attitudes toward industry interactions. Students were more approving of
gifts to physicians or medical students than to government officials.
Certain attitudes appeared to change during medical school, though a time
trend was not performed; for example, clinical students
(53%–71%) were more likely than preclinical students
(29%–62%) to report that promotional information helps
educate about new drugs.
Conclusions:
Undergraduate medical education provides substantial contact with
pharmaceutical marketing, and the extent of such contact is associated with
positive attitudes about marketing and skepticism about negative
implications of these interactions. These results support future research
into the association between exposure and attitudes, as well as any
modifiable factors that contribute to attitudinal changes during medical
education.
:
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review. PLoS Med 8(5): e32767. doi:10.1371/journal.pmed.1001037
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001037
Souhrn
Background:
The relationship between health professionals and the pharmaceutical industry
has become a source of controversy. Physicians' attitudes towards the
industry can form early in their careers, but little is known about this key
stage of development.
Methods and Findings:
We performed a systematic review reported according to PRISMA guidelines to
determine the frequency and nature of medical students' exposure to the
drug industry, as well as students' attitudes concerning pharmaceutical
policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from
the earliest available dates through May 2010, as well as bibliographies of
selected studies. We sought original studies that reported quantitative or
qualitative data about medical students' exposure to pharmaceutical
marketing, their attitudes about marketing practices, relationships with
industry, and related pharmaceutical policy issues. Studies were separated,
where possible, into those that addressed preclinical versus clinical
training, and were quality rated using a standard methodology. Thirty-two
studies met inclusion criteria. We found that 40%–100%
of medical students reported interacting with the pharmaceutical industry. A
substantial proportion of students (13%–69%) were
reported as believing that gifts from industry influence prescribing. Eight
studies reported a correlation between frequency of contact and favorable
attitudes toward industry interactions. Students were more approving of
gifts to physicians or medical students than to government officials.
Certain attitudes appeared to change during medical school, though a time
trend was not performed; for example, clinical students
(53%–71%) were more likely than preclinical students
(29%–62%) to report that promotional information helps
educate about new drugs.
Conclusions:
Undergraduate medical education provides substantial contact with
pharmaceutical marketing, and the extent of such contact is associated with
positive attitudes about marketing and skepticism about negative
implications of these interactions. These results support future research
into the association between exposure and attitudes, as well as any
modifiable factors that contribute to attitudinal changes during medical
education.
:
Please see later in the article for the Editors' Summary
Zdroje
1. BrennanTRothmanDBlankLBlumenthalDChimonasSC
2006
Health industry practices that create conflicts of interest: a
policy proposal for academic medical centers.
JAMA
295
429
433
2. WilsonD
18 Nov 2009
Medical schools quizzed on ghostwriting.
New York Times. Available: http://www.nytimes.com/2009/12/08/health/policy/08grassley.html?scp=11&sq=&st=nyt.
Accessed 1 November 2010
3. Institute of Medicine
2009
Conflict of interest in medical research, education, and
practice
Washington (D.C.)
The National Academies Press
4. WazanaA
2000
Physicians and the pharmaceutical industry: is a gift ever just a
gift?
JAMA
283
373
380
5. LexchinJBeroLDjulbegovicBClarkO
2003
Pharmaceutical industry sponsorship and research outcome and
quality: a systematic review.
BMJ
326
1167
1177
6. AvornJ
2004
Powerful medicines: the benefits, risks, and costs of prescription
drugs
New York
Knopf
7. AvornJChoudhryN
2010
Funding for medical education: maintaining a healthy separation
from industry.
Circulation
121
2228
2234
8. KesselheimASMelloMMStuddertDM
2011
Strategies and practices in off-label marketing of
pharmaceuticals: a retrospective analysis of whistleblower
complaints.
PLoS Med
8
e1000431
doi:10.1371/journal.pmed.1000431
9. LandefeldCSSteinmanMA
2009
The Neurontin legacy–marketing through misinformation and
manipulation.
N Engl J Med
360
103
106
10. ZieglerMGLewPSingerBC
1995
The accuracy of drug information from pharmaceutical sales
representatives.
JAMA
273
1296
1298
11. HaayerF
1982
Rational prescribing and sources of information.
Social Sci Med
16
2017
2023
12. ChrenM-MLandefeldCS
1994
Physicians' behavior and their interactions with drug
companies: a controlled study of physicians who requested additions to a
hospital drug formulary.
JAMA
271
684
689
13. ManchandaPHonkaE
2005
The effects and role of direct-to-physician marketing in the
pharmaceutical industry: an integrative review.
Yale J Health Policy Law & Ethics
5
785
812
14. AvornJChenMHartleyR
1982
Scientific versus commercial sources of influence on the
prescribing behavior of physicians.
Amer J Med
73
4
8
15. CaudillTSJohnsonMSRichECMcKinneyWP
1996
Physicians, pharmaceutical sales representatives, and the cost of
prescribing.
Arch Fam Med
5
201
206
16. BerensonA
21 Aug 2005
For Merck, Vioxx paper trail won't go away.
New York Times. Available: http://www.nytimes.com/2005/08/21/business/21vioxx.html.
Accessed 1 November 2010
17. KornDEhringhausS
2007
The scientific basis of influence and reciprocity: a symposium
Washington (D.C.)
Association of American Medical Colleges
18. ErlangerHSKlegonDA
1978
Socialization effects of professional school.
Law & Soc Rev
13
11
35
19. MaheuxBBelandF
1987
Changes in students' sociopolitical attitudes during medical
school: socialization or maturation effect?
Social Sci Med
24
619
624
20. CrandallSDavidSBroesekerAHildebrandtC
2008
A longitudinal comparison of pharmacy and medical students'
attitudes toward the medically underserved.
Am J Pharm Educ
72
article 148
21. PapadakisMATeheraniABanachMAKnettlerTRRathnerSL
2005
Disciplinary action by medical boards and prior behavior in
medical school.
N Engl J Med
353
2673
2682
22. McCormickBTomlinsonGBrill-EdwardsPDetskyA
2001
Effect of restricting contact between pharmaceutical company
representatives and internal medicine residents on post-training attitudes
and behavior.
JAMA
286
1994
1999
23. AMSA PharmFree Scorecard
2008–2009
(updated 24 August 2010)
Reston (Virginia)
American Medical Student Association
Available: http://www.amsascorecard.org/. Accessed 1 November
2010
24. University of Pittsburgh Medical Center
12 November 2007
Policy on conflicts of interest and interactions between representatives
of certain industries and faculty, staff, and students of the Schools of
Health Sciences and personnel employed by UPMC at all domestic
locations
Pittsburg (Pennsylvania)
University of Pittsburgh
Available: http://www.coi.pitt.edu/industryrelationships/Policies/IndustryRelationshipsPolicy.pdf.
Accessed 1 November 2010
25. Stanford University School of Medicine
October 2006
(updated 22 July 2010) Policy and guidelines for interactions between
the Stanford University School of Medicine, the Stanford Hospital and
Clinics, and Lucile Packard Children's Hospital with the
pharmaceutical, biotech, medical device, and hospital and research equipment
and supplies industries
Stanford (California)
Stanford University School of Medicine
Available: http://med.stanford.edu/coi/siip/policy.html#iv. Accessed 1
November 2010
26. StosselT
2008
Has the hunt for conflicts of interest gone too far?
Yes.
BMJ
336
476
27. WilsonD
2 March 2009
Harvard Medical School in ethics quandary.
New York Times. Available: http://www.nytimes.com/2009/03/03/business/03medschool.html.
Accessed 1 November 2010
28. GlaserBBeroL
2005
Attitudes of academic and clinical researchers towards financial
ties in research: a systematic review.
Science and Engineering Ethics
11
553
573
29. LicurseABarberEJoffeSGrossC
2010
The impact of disclosing financial ties in research and clinical
care: a systematic review.
Arch Intern Med
170
675
682
30. SarikayaOCivanerMVatanseverK
2009
Exposure of medical students to pharmaceutical marketing in
primary care settings: frequent and influential.
Adv in Health Sci Educ
14
713
724
31. FeinEVermillionMUijtdehaagS
2007
Pre-clinical medical students' exposure to and attitudes
toward pharmaceutical industry marketing.
Med Educ Online
12
Available: http://www.med-ed-online.net/index.php/meo/article/viewArticle/4465.
Accessed 1 November 2010
32. BallDAl-ManeaS
2007
Exposure and attitudes to pharmaceutical promotion among pharmacy
and medical students in Kuwait.
Pharmacy Education
7
303
313
33. Al KhajaKHanduSMathurJSequeiraR
2005
Assessing prescription writing skills of pre-clerkship medical
students in a problem-based learning curriculum.
Int J Clin Pharmacol Ther
43
429
435
34. VinsonDMcCandlessBHosokawaM
1993
Medical students' attitudes toward pharmaceutical marketing:
possibilities for change.
Fam Med
25
31
33
35. LeaDSpigsetOSlordalL
2010
Norwegian medical students' attitudes towards the
pharmaceutical industry.
Eur J Clin Pharmacol
66
727
733
36. TichelaarJRichirMAvisHScholtenHAntoniniN
2010
Do medical students copy the drug treatment choices of their
teachers or do they think for themselves?
Eur J Clin Pharmacol
66
407
412
37. GrandeDFroschDPerkinsAKahnB
2009
Effect of exposure to small pharmaceutical promotional items on
treatment preferences.
Arch Intern Med
169
887
893
38. MarkhamFDiamondJFayockK
2009
The effect of a seminar series on third year students'
attitudes toward the interactions of drug companies and
physicians.
The Internet Journal of Family Practice
7
Available: http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijfp/vol7n1/series.xml.
Accessed 1 November 2010
39. VolodinaASaxSAndersonS
2009
Corporate social responsibility in countries with mature and
emerging pharmaceutical sectors.
Pharmacy Practice
7
Available: http://www.pharmacypractice.org. Accessed 1 November
2010
40. TardifLBaileyBBussieresJLebelDSoucyG
2009
Perceived advantages and disadvantages of using drug samples in a
university hospital center: a case study.
Ann Pharmacother
43
57
63
41. StraandJChristensenJ
2008
The quality of pharmaceutical consultant visits in general
practice.
Tidsskr Nor Laegeforen
128
555
557
42. HassaliMKongDStewartK
2007
A comparison between senior medical students' and pharmacy
pre-registrants' knowledge and perceptions of generic
medicines.
Med Educ
41
703
710
43. SierlesFBrodkeyAClearlyLMcCurdyFAMintzM
2005
Medical students' exposure to and attitudes about drug
company interactions.
JAMA
294
1034
1042
44. WoffordJOhlC
2005
Teaching appropriate interactions with pharmaceutical company
representatives: the impact of an innovative workshop on student
attitudes.
BMC Med Educ
8
5
12
45. StanleyAJacksonDBarnettD
2005
The teaching of drug development to medical students:
collaboration between the pharmaceutical industry and medical
school.
Br J Clin Pharmacol
69
464
474
46. MonaghanMTurnerPHoughtonBMarkertRJGaltKA
2003
Pharmacotherapy cost comparison among health professional
students.
Am J Pharm Educ
67
article 81
47. MonaghanMGaltKTurnerPHoughtonBLRichEC
2003
Student understanding of the relationship between the health
professions and the pharmaceutical industry.
Teach Learn Med
15
14
20
48. WilkesMHoffmanJR
2001
An innovative approach to educating medical students about
pharmaceutical promotion.
Acad Med
75
1271
1277
49. SandbergWCarlosRSandbergERoizenM
1997
The effect of educational gifts from pharmaceutical firms on
medical students' recall of company names or products.
Acad Med
72
916
918
50. HodgesB
1995
Interactions with the pharmaceutical industry: experiences and
attitudes of psychiatry residents, interns and clerks.
Can Med Assoc J
153
553
559
51. WeberMAugerCClerouxR
1986
Knowledge of medical students, pediatric residents, and
pediatricians about the cost of some medications.
Pediatr Pharmacol (New York)
5
281
285
52. PalmisanoPEdelsteinJ
1980
Teaching drug promotion abuses to health professional
students.
J Med Educ
55
453
454
53. VuorenkoskiLValtaMHelveO
2008
Effect of legislative changes in drug promotion on medical
students: questionnaire survey.
Med Educ
42
1172
1177
54. FabbriAArdigoMGrandoriLRealiCBodiniC
2008
Conflicts of interest between physicians and the pharmaceutical
industry. A quali-quantitative study to assess medical students'
attitudes at the University of Bologna.
Ricerca Sul Campo
24
242
254
55. FitzMHomnaDReddySGriffithCBakerE
2007
The hidden curriculum: medical students' changing opinions
toward the pharmaceutical industry.
Acad Med
82
S1
S3
56. HymanPHochmanMShawJSteinmanM
2007
Attitudes of preclinical and clinical medical students toward
interactions with the pharmaceutical industry.
Acad Med
82
94
99
57. VainiomakiMHelveOVuorenkoskiL
2004
A national survey on the effect of pharmaceutical promotion on
medical students.
Med Teach
26
630
634
58. BellinMMcCarthySDrevlowLPierachC
2004
Medical students' exposure to pharmaceutical industry
marketing: a survey at one U.S. medical school.
Acad Med
79
1041
1045
59. BarfettJLantingBLeeJLeeMNgV
2004
Pharmaceutical marketing to medical students: the student
perspective.
McGill J Med
8
21
27
60. BarryDCyranEAndersonR
2000
Common issues in medical professionalism: room to
grow.
Amer J Med
108
136
142
61. MantyrantaTHemminkiE
1994
Medical students and drug promotion.
Acad Med
69
736
62. BarnesCHolcenbergJ
1971
Student reactions to pharmaceutical promotion
practices.
Northwest Med
70
262
266
63. LiberatiAAltmanDGTetzlaffJMulrowCGøtzschePC
2009
The PRISMA statement for reporting systematic reviews and
meta-analyses of studies that evaluate health care interventions:
explanation and elaboration.
Ann Intern Med
151
W65
W94
64. CarmodyDMansfieldP
2010
What do medical students think about pharmaceutical
promotion?
Australian Med Student J
1
56
59
65. American Association of Medical Colleges
26 Oct 2009
2009 medical school graduation questionnaire: all schools summary
report.
Available: http://www.aamc.org/data/gq/allschoolsreports/gqfinalreport_2009.pdf.
Accessed 1 November 2010
66. HaffertyFFranksR
1994
The hidden curriculum, ethics teaching, and the structure of
medical education.
Acad Med
69
861
871
67. HaffertyF
1998
Beyond curriculum reform: confronting medicine's hidden
curriculum.
Acad Med
73
403
407
68. HojatMVergareMMaxwellKBrainardGHerrineSK
2009
The devil is in the third year: a longitudinal study of erosion
of empathy in medical school.
Acad Med
84
1182
1191
69. WoloschukWHarasymPTempleW
2004
Attitude change during medical school: a cohort
study.
Medical Education
38
522
534
70. RabinowitzH
1990
The change in specialty preference by medical students over time:
an analysis of students who prefer family medicine.
Fam Med
22
62
63
71. HigginsJThompsonS
2004
Controlling the risk of spurious findings from
meta-regression.
Stat Med
23
1663
1682
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