About four-fifths of U.S. doctors in a survey said they took gifts or money from drug and medical-device makers last year, a drop from 94 percent in 2004, after medical schools and hospitals adopted tougher rules.
Almost 84 percent of the 1,891 physicians participating in the survey told researchers they accepted items such as drug samples, tickets to cultural or sports events, and food and beverages in the workplace, according to a report today in the Archives of Internal Medicine. Doctors also had companies pick up meeting expenses or provide fees for speaking on behalf of a product or for consulting.
Policies adopted since 2006 at some medical schools and teaching hospitals forbid physicians from accepting free drugs and food and limit company representatives to clinical areas. The rules represent a lower tolerance for the behavior by the public and groups such as Institute of Medicine and the American Association of Medical Colleges, both of which are based in Washington, said Eric G. Campbell, the study’s lead author.
“The data clearly show that relationships have dropped dramatically,” said Campbell, director of research at the Mongan Institute for Health Policy, in Boston. “And while the drug representatives tell the doctors that these gifts mean nothing, studies show that accepting anything of value, even things of essentially no value, establishes a reciprocity between the person who gives the gift and the one who receives it.”
Drug and device makers spend millions of dollars each year to develop relationships with doctors who then might decide to use or recommend their products. Medical professionals “delude themselves that it doesn’t matter,” Campbell said.
Private physicians, who don’t have any regulations imposed on them, are more likely to accept handouts, the researchers found. More than 90 percent reported taking gifts or money from industry, compared with 72 percent for doctors working for a university and 71 percent for hospital physicians, according to the survey. Among doctors, cardiologists showed the highest willingness, at 92 percent, to take the handouts.
Doctors with industry relationships tend to prescribe brand-name drugs at a higher rate than those without these ties, the study found. The relationships may lead to higher health costs, Campbell said. Regions in the U.S. with lower medical costs have a reduced incidence of the gift-giving practices, according to the study.
Handouts for Rich
Among the most-common practices was accepting drug samples, at 64 percent, or food and beverages, at 71 percent, said Campbell, who is also an associate professor of medicine at Harvard Medical School in Boston. While free samples may provide access to drugs for poorer patients, studies show that a majority of the handouts go to people who are richer and have insurance or to the doctors and their families, Campbell said.
The degree to which doctors take handouts of food and beverages is “absolutely embarrassing,” Campbell said.
“Physicians and their office staff should essentially feed themselves and not eat lunch on the backs of the American public in the form of higher drug prices,” Campbell said in the interview.
Companies also enrich doctors by paying them to give scripted speeches on behalf of a product, or by providing “trips to Florida to play golf for three days under the guise of a continuing-education meeting,” Campbell said.
About 7 percent of the doctors surveyed said they were paid to consult on the development of drugs or devices. Campbell said he isn’t sure those relationships should disappear.
Consulting may be “the only way companies can have the access to people with the real knowledge,” Campbell said. He also supports paying doctors for enrolling patients in drug trials, he said.
The study was funded by the Institute on Medicine as a Profession in New York.