Medical students in the United States are frequently exposed to pharmaceutical marketing, even in their preclinical years, and the extent of their contact with industry is associated with positive attitudes about marketing and skepticism towards any negative implications. These findings from research led by Kirsten Austad and Aaron S. Kesselheim from the Harvard Medical School in Boston, USA, published in this week's PLoS Medicine, suggest that strategies to educate students about interactions with the pharmaceutical industry should directly address widely-held misconceptions about the effects of marketing.
The authors examined all published studies on this topic and collected the results from a total of 9,850 medical students studying at 76 medical schools. The authors found that most students had some form of interaction with the pharmaceutical industry and that contact increased in the clinical years, with up to 90% of all clinical students receiving some form of educational materials. Most students thought it was ethically permissible to accept gifts from drug manufacturers and justified their entitlement to gifts by citing financial hardship or by asserting that most other students accepted gifts. Almost two-thirds of students reported that they were immune to bias induced by promotion, gifts, or interactions with sales representatives. Student opinions were split on whether physician-industry interactions should be regulated either by medical schools or the government.
The authors recommend that in addition to better education for medical students on the subject of physician-industry relationships, institutions can help by supporting reforms such as rules limiting the contact students have with pharmaceutical industry marketing. However, change may be difficult due to the influence of the so-called "hidden curriculum," or the effect of attitudes and other behavioural cues expressed by peers and role models. They say: "Given the potential for educational and institutional messages to be counteracted by the hidden curriculum, changes should be directed at faculty and residents who serve as role models for medical students."
The authors conclude: "These changes can help move medical education a step closer to two important goals: the cultivation of strong professional values, as well as the promotion of a respect for scientific principles and critical review of evidence that will later inform clinical decision-making and prescribing practices."
Funding: Study funded by a grant from the Edmond J. Safra Center for Ethics at Harvard University. Dr. Kesselheim is supported by a career development award from the Agency for Healthcare Research & Quality (K08HS18465-01), and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: KEA reports employment by the USMLE preparation company USMLERx to write content question for their Step 1 question bank and is a 3rd year medical student at Harvard Medical School and a lab fellow at the Edmond J. Safra Center for Ethics at Harvard University and a member of the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital.
Citation: Austad KE, Avorn J, Kesselheim AS (2011) Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review. PLoS Med 8(5): e1001037. doi:10.1371/journal.pmed.1001037
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Aaron S. Kesselheim, M.D., J.D.
Division of Pharmacoepidemiology and Pharmacoeconomics
Department of Medicine
Brigham and Women's Hospital and Harvard Medical School
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United States of America
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