Drug companies spend billions of dollars on advertising to consumers online, in print and TV. Their ads are such an everyday part of the media landscape that Saturday Night Live can run a skit mocking the hilarious and scary list of disclaimers about side effects and everyone is in on the joke.
And that’s just the advertising directed at consumers. The big targets for pharmaceutical marketing are the doctors with the power to prescribe these medications. One review in the Journal of the American Medical Association found that most physicians met with pharmaceutical representatives about four times a month. This level of interaction—not just seeing TV ads or billboards, but dealing directly with sales reps—starts early too. In a recent survey of incoming medical students at the University of Chicago Pritzker School of Medicine, 62 percent had already interacted directly with pharmaceutical companies, either by accepting small gifts or attending sponsored social events and dinners.
Shalini Reddy, an associate professor of medicine and one of the authors of the study, said, “We always think of premed students coming in having little exposure to the medical profession. But we don’t think about what happens while they’re shadowing physicians or doing volunteer work.”
The report, published in Academic Medicine, includes a survey of students matriculating at Pritzker from 2007 to 2010 that asked about their interactions with pharmaceutical marketing. Of the 62 percent who had some direct exposure, 50 percent had accepted a promotional item like a pen from a drug rep, and 38 percent had attended a sponsored lunch. Nearly 25 percent had received some other kind of small gift, and 20 percent had attended a dinner sponsored by a pharmaceutical firm.
The report also includes a second survey that asked students about whether they view this kind of interaction as professional or unprofessional. A smaller percentage, about 23 percent, said accepting a pen was professional or somewhat professional. Surprisingly, only slightly fewer students, about 21 percent, viewed a much bigger commitment such as attending a social event, dinner or golf outing as professional.
“We were surprised that a lot of incoming students who had participated in or observed this behavior thought that it was okay to do,” said Reddy.
The study began as a side project by Laura Hodges, who was a third-year student at Pritzker at the time and is now a resident at Brown University. Reddy said Hodges had told her about how she had either attended or heard about lectures with food brought in by pharmaceutical representatives. She said that it was often hard to tell who was with the drug companies and not. Hodges decided to develop a survey to find out just how often incoming students interacted directly with drug reps.
“Attending those lectures hit home for me because, as a trainee, I’m acquiring knowledge that’s setting the foundation for my lifelong practice of medicine,” Hodges said in an email. “It’s important that I know where that information is coming from.”
Reddy said this kind of marketing, especially when it begins so early in a physician’s career, has an impact on how they make decisions about medications.
“You’re making your decisions not because there’s good data to support your decisions, you’re making it based on retailing,” she said. “When I was in medical school studying pharmacology, I remembered the medications I had seen before on drug rep pens and note pads. We learn about a number of different drugs in one class of medicines. The drugs I always remembered were the ones where I saw the advertising. It almost subconsciously gets into the way you practice.”
Pritzker has courses for first-year medical students about the ethics of dealing with pharmaceutical companies. Students learn about the history of drug marketing and study scenarios showing interactions between physicians and sales reps. Reddy said the goal is to give the students guidelines about how to approach different scenarios. “We can’t protect them from it but we can teach them to respond critically,” she said.
Perhaps the most important audience for this kind of training isn’t young, impressionable medical students, but the practicing physicians who are their role models.
“When premed students interact with doctors, that physician is their role model and they seek to emulate them. If they see their role model participating in it, they’re much more likely to think it’s okay,” Reddy said. And this audience may be the hardest to reach.
“There is a lot of literature that shows most doctors don’t think they’re impacted by pharmaceutical ads, but their colleagues are,” Reddy said. “Raising awareness will certainly help.”
Hodges LE, Arora VM, Humphrey HJ, & Reddy ST (2012). Premedical Students’ Exposure to the Pharmaceutical Industry’s Marketing Practices. Academic medicine : journal of the Association of American Medical Colleges PMID: 23269292