Table 1.
Summary of Articles Included in Review
| Study | Population | N* | Methods | Intervention | Main Results |
|---|---|---|---|---|---|
| Educational interventions | |||||
| Watkins and Kimberly10 (2004) | IM† residents and faculty | 85/88, 86/109 | Needs assessment, survey pre and post | Integrated 4-unit curriculum using small and large group seminars | All residents reported increased awareness of patients' perceptions, how to identify conflict of interest, and feeling more prepared to interact with pharmaceutical representatives |
| Wilkes and Hoffman11 (2001) | Medical students | 120/136 | Survey, pre and post | Mock pharmaceutical representative presentation with discussion, literature search tools | Intervention increased belief that sponsored trips cause bias and advertisements are not educational. Many students who initially felt issues were not problematic became uncertain of their ethical position |
| Kelcher et al.12 (1998) | FP residents | 12/15 | Survey | Educational seminar and 8 actual pharmaceutical representative presentations | 92% of residents felt better prepared to interact with pharmaceutical representatives after the seminar |
| Hopper et al.13 (1997) | IM faculty, IM residents | 14/18, 28/31 | Survey, pre and post | 40-min lecture/discussion | Postintervention residents more likely to agree that pharmaceutical representatives can be unethical, marketing can be inappropriate, and prescribing can be influenced |
| Shear et al.14 (1996) | FP residents, medical students | N/A | Descriptive | 1-h video and discussion of physician/detailer interaction | No formal outcomes |
| Anastasio et al.15 (1996) | FP residents | 29/30 | Survey, pre and post | Educational seminar with role play and feedback | Increased confidence in meeting 10 goals of interaction with pharmaceutical representatives |
| Shaughnessy et al.16 (1995) | FP residents | 12/12 | Validated survey, pre and post | Lecture/discussion and evaluation of actual pharmaceutical representative presentation | More likely to believe that pharmaceutical representatives influence prescribing, less likely to believe they support important conferences and speakers |
| Vinson et al.17 (1993) | Medical students | 134/214 | Survey | 50-min lecture/discussion | “Marketing practice acceptability” score showed students less accepting of pharmaceutical representatives postintervention |
| Palmisano and Edelstein18 (1980) | Medical students, nurse practitioner students | 100/100, 95/100 | Survey, pre only | 90-min seminar to introduce students to drug industry strategies | 85% of medical students think it is improper for public official to take gift; 46% think it is improper for medical students to do same |
| Daniel and Leedham19 1966 | Medical, pharmacy, and dental students | 197/227, 98/101, 25/25 | Survey | Small group evaluation of drug advertising as part of pharmacology course | Students more skeptical of drug company claims |
| Garb20 1960 | Medical students | N/A | Descriptive | Evaluation of drug company ads, pharmaceutical representative presentations | 11 of 26 companies found to be reliable |
| Knowledge, attitudes, practices, and other research | |||||
| Keim et al.21 (2004) | EM program directors | 106/125 | Survey | Attitudes and practices toward industry interactions | Majority accepted industry support, while >90% agreed that industry support is an attempt to change prescribing |
| Brett et al.22 (2003) | IM residents and faculty | 39/42, 37/51 | Survey | Which pharmaceutical industry gifts are ethically problematic? | Most activities not believed to create ethical problems |
| Monaghan et al.23 (2003) | Medical, pharmacy, and nurse practitioner students | 59/108, 53/94, 17/17 | Survey | Knowledge and attitudes toward the pharmaceutical industry | Medical students were unsure of the usefulness of interactions and felt that most types of gifts were appropriate |
| Boltri et al.24 (2002) | FP residents and faculty | 24, 8 (clinic totals) | Sample use tracking | Prescriptions for patients with hypertension, pre and postrestriction of samples | Prescribing of first-line antihypertensive medication by residents increased from 39% to 72% after sample availability was restricted |
| Chakrabarti et al.25 (2002) | Psychiatry chief residents and program directors | 12/16, 15/16 | Survey | Attitudes, awareness of guidelines, and perceptions of compliance with guidelines | 75% unaware or noted absence of policy on industry influence, and 11% described influence of industry on their program as “restricted” |
| Wolfsthal et al.26 (2002) | IM program directors | 287/394 | Program Survey | Factors that correlate with American Board of Internal Medicine (ABIM) program pass rate | Financial support for residency programs from industry is a negative predictor of ABIM pass rates |
| McCormick et al.27 (2001) | IM residency graduates | 205/299 | Survey | Association between industry policy in residency and future behavior | Presence of policy negatively associated with perceived benefit of pharmaceutical representative information, OR 0.37 (95% CI 0.14 to 0.96) |
| Schwartz et al.28 (2001) | Patients admitted by psychiatry residents | N/A | Chart review | Prescriptions for psychiatric patients newly enrolled in a resident clinic | Choice of initial medication associated with recent pharmaceutical representative visits for that medication |
| Sigworth29 (2001) | IM residents | 164/181 | Interview and survey | Branded items carried in white coat pockets | 97% carried at least 1 branded item, median 4 items |
| Steinman et al.30 (2001) | IM residents | 105/117 | Survey | Resident attitudes and practices towards industry gifts | Residents found most gifts appropriate and felt their own prescribing was not influenced, while others' can be |
| Ferguson31 (1999) | IM residency graduates | 346/865 | Survey | Current interactions with pharmaceutical representatives, presence of policy in residency | Presence of policy in residency did not predict likelihood of interaction with pharmaceutical representatives or acceptance of samples |
| Razack et al.32 (1999) | Pediatric residency program | N/A | Descriptive | Program experience with policy development | An example of attempt to address conflicts of interest |
| Brewer33 (1998) | FP residents | N/A | Prescription inventory | Prescriptions at 3 residencies with differing sample policies | Greater use of generics seen at programs with limited or no medication samples. No cost differences |
| Gibbons et al.34 (1998) | Residents and practicing physicians, patients | 268/394, 196/200 | Survey | Physician and patient attitudes | Patients found gifts more influential than physicians, but patients more likely than doctors to find several kinds of gifts appropriate |
| Mahood et al.35 (1997) | FP program directors | 16/16 | Survey | Presence of policy or curriculum, extent of industry interaction | 4 of 16 FP programs had policies, 13 taught critical appraisal of industry claims, 4 taught industry marketing techniques |
| Sandberg et al.36 (1997) | Medical students | 205/205 | Survey | Recall of drug company name after receipt of textbooks as gifts | 90% received at least 1 free book, 25% recalled name of company |
| Shaughnessy and Bucci37 (1997) | FP residents and program directors | 248/800, 232/436 | Survey | Knowledge, attitudes, and behavior related to sample medication use | Samples were valued and used often; training regarding sample use was not viewed as adequate |
| Sergeant et al.38 (1996) | FP residents | 226/262 | Survey | Attitudes, knowledge, self-reported behavior | 82% approved of industry interaction, 58% found industry literature useful, and 34% believed pharmaceutical representatives influenced prescribing |
| Spingarn et al.39 (1996) | IM residents | 75 | Survey, retrospective cohort | Knowledge of Lyme disease treatment and information recall after grand rounds by pharmaceutical representative | Attendees (n=22) more likely to name company drug for complicated Lyme disease, less likely to name appropriate drug for mild disease |
| Stryer and Bero40 (1996) | IM residency, HMO, private practice | N/A | Assessment of promotional items | Compliance with FDA regulations | 42% of items failed to comply with at least 1 regulation; items favor the distributing company |
| Hodges41 (1995) | Psychiatry residents and students | 74/106 | Validated survey | Attitudes, extent of interaction with pharmaceutical representatives | 77% felt pharmaceutical representatives support important conferences; 57% felt promotional items do not affect prescribing |
| Ziegler et al.42 (1995) | IM residents | 27/N/A | Survey, pharmacist transcription | Accuracy of drug information stated during pharmaceutical representative presentations | 12 of 106 (11%) statements were incorrect; 26% of residents recalled hearing a false statement |
| Johnstone and Valenzuela43 (1995) | Anesthesia residency program | N/A | Descriptive | Departmental experience with pharmaceutical industry | Industry influence was pervasive and often unethical; restrictions on pharmaceutical representative activity were instituted |
| Reeder et al.44 (1993) | EM chief residents | 72/87 | Survey | Extent of pharmaceutical representative involvement, attitudes | 80% felt programs benefit from industry presence, and 20% felt their own prescribing habits were affected |
| Keim et al.45 (1993) | EM residents and program directors | 1385/1836, 80/81 | Survey | Attitudes and self-reported behaviors | 60% of residents felt gifts were appropriate, 74% felt pharmaceutical representatives cross ethical boundaries, and 49% felt they affect prescribing |
| Brotzman and Mark46 (1993) | FP residents | 265/378 | Survey | Attitudes stratified by type of policy (“unrestricted” vs “restricted” residency) | Unrestricted program residents more likely to view interaction as beneficial, view detailing as helpful, and view gifts as appropriate |
| Lichstein et al.47 (1992) | IM program directors | 272/444 | Survey | Extent of industry involvement, attitudes | 88% allowed industry sponsored conferences, 67% felt benefits outweighed risks, and 35% had formal policy |
| Banks and Mainous48 (1992) | Medical school faculty | 248/462 | Survey | Attitudes of medical school faculty toward American Medical Association guidelines | Majority felt samples and gifts do not influence prescribing, and 66% felt personal pharmaceutical representative relationship does influence prescribing |
| Brotzman and Mark49 (1992) | FP programs | 328/386 | Survey | Presence of policies regarding industry interactions | 58% had policy; 41% had prohibitions |
| Bucci and Frey50 (1992) | FP program directors | 325/383 | Survey | Level of pharmaceutical curriculum development | Presence of pharmacy faculty associated with presence of curricula to evaluate industry marketing materials and presence of guidelines |
| Morelli and Koenigsburg 51 (1992) | Drug samples in FP residency | N/A | Samples inventory and tracking | Characteristics of the distribution of samples | 54% of samples given to patients, 46% family/self/other, 39% economic rationale, and 53% therapeutic rationale; simultaneous written prescription matched sample brand 100% of time |
| McKinney et al.52 (1990) | IM faculty and residents | 277/335, 190/240 | Validated survey | Attitudes | 23% faculty/15% residents felt physicians cannot ever be compromised; both denied influence of contact on their own prescribing behavior |
| Lurie et al. 53 (1990) | IM faculty and residents | 240/309, 131/175 | Survey | Reported number of pharmaceutical representative contacts, self-reported behavior | 25% faculty/32% residents changed practice based on a discussion with a representative |
*
Presented as number of respondents/total number of subjects available.
†
IM, Internal Medicine; EM, emergency medicine; FP, family practice; N/A, not available or not applicable.