Gifts, meals and even money given to U of T medical students by drug companies have dramatically influenced the way graduates think about the pharmaceutical industry, according to the Journal of the American Medical Association.
The world-renowned journal found U of T internal medicine graduates were more likely to allow drug companies to guide their practices than their counterparts at McMaster—which banned gift giving from drug companies in 1992.
“This study sent up a warning flare,” said prominent ethicist Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba. “There’s something worrying about graduates relying on biased information.”
Critics say the findings may have dire implications for patients, who may be prescribed drugs that are not the most appropriate for their care or are more expensive than other equally effective brands.
“Physicians should not accept gifts from the industry for two reasons: it’s liable to affect their prescribing, and…it violates the relationship of trust with their patients,” said Dr. Gordon Guyatt, head of internal medicine at McMaster.
The researchers surveyed about 200 internal medicine residents who had graduated from McMaster and U of T between 1990 and 1996. Graduates from both universities received gifts, free meals, honoraria and invitations to drug company-sponsored events, as well as participating in meetings with drug company representatives in their offices. However, McMaster residents who graduated after the restriction policy was in place were 56 per cent less likely to find pharmaceutical company information helpful than the U of T graduates.
“It’s the money that is talking rather than the principles,” said Peter Drury, head of information policy at the National Health Service.
“No one’s asked the patients if they want to donate extra money to doctors so that they can receive gifts from the pharmaceutical industry,” added Guyatt.
But U of T isn’t overly worried.
Dr. Murray Urowitz, dean of postgraduate medicine at U of T, said the university has already introduced measures to regulate, but not prohibit, residents’ contact with drug company representatives.
“We deal in the real world, and prohibition never works,” said Urowitz.
“We should tell people how to handle the real world rather than bar them from it…Just like we teach [trainees] how to examine a heart or lung, we teach them how to interact with those influences… which are going to influence their medical decision making.”
U of T’s 1,800 postgraduate physician trainees attend 8 sessions in bioethics during their schooling. In one session, residents, ethicists and pharmaceutical company representatives meet to discuss the possible ethical dilemmas created by pharmaceutical company “freebies.”
Guidelines adopted in 1996 mandate that the primary objective of physician-drug company interaction is the advancement of patient care through education and research.
Physician trainees must disclose the nature of the relationship with industry to patients and not accept personal rewards from industry.
Second year medical student Adam Fleming is concerned about drug company influence but believes that at his level, most students do not receive many gifts and are not entirely aware of the extent of the pharmaceutical industry’s influence.
“I don’t think there is a single person in our class who wouldn’t get defensive if you told them they were being influenced by drug companies.”
Regardless of what students think, the national representative of university professors says the freebies do have an effect.
“The drug companies aren’t going to spend millions of dollars on advertising to doctors if it’s not going to change prescribing practice,” said Jim Turk, executive director of the Canadian Association of University Teachers.
