Medical Students Receive Constant
Gifts From Drug Companies
When a doctor prescribes a particular drug, it can sometimes
be due to the influence of drug company promotions, and that influence
begins in medical school, a new study contends.
Third-year medical students get, on average, one gift or attend
one activity sponsored by a drug maker each week. Most students
believe these events are likely to be biased, and say they aren't
swayed by marketing to look more favorably on the company's products.
"Basically, we have medical students exposed to marketing," said
study author Dr. Frederick S. Sierles, a professor of medicine
at Rosalind Franklin University of Medicine and Science, in North
Chicago, Ill. "We know the marketing is biased in favor of the
products. We know the students don't think they are being influenced.
So they're being set up to be influenced without knowing it, and
to prescribe in a way that is going to be bad for their patients."
The study appears in the Sept. 7 issue of the Journal of the
American Medical Association, a themed issue on medical education.
The marketing by pharmaceutical companies to students begins
even before students enter medical school, Sierles said. "This
contact with drug companies begins in the weeks and months after
students graduate from college. By the third year of medical school,
they are being saturated with this," he said.
However, the majority of students felt they would not be influenced
by sponsored activities or gifts, Sierles said. "You have to bear
in mind that the majority of residents and attending physicians
don't think they're going to be influenced either," he added.
Sierles noted there is evidence from other studies that the programs
and gifts offered by drug makers do influence what drugs are prescribed.
To collect their data, Sierles and his colleagues sent anonymous
questionnaires to 1,143 third-year medical students at eight medical
The researchers found that 93.2 percent of the students were
asked or required by a physician to attend at least one drug company-sponsored
lunch. "So, this practice is supported by the doctors that supervise
and work with students," Sierles said.
In addition, 68.8 percent of the students believed gifts would
not influence their practices, and 57.7 percent thought gifts
would not affect colleagues' practices. "But there was also a
tendency for students to feel that their fellow medical students
were more apt to be influenced than they were," Sierles said.
Moreover, 80.3 percent of the students believed they were entitled
The vast majority of students didn't know if their school or
the national medical organizations they belonged to had a policy
governing the acceptance of gifts and meals from drug companies,
Sierles said the result of this influence is that students will
take this marketing seriously and "mis-prescribe" medications.
"They are more likely to prescribe the marketed products than
prescribe what they should be prescribing. That's a big danger,"
Students haven't been taught how to handle this marketing, Sierles
said. He believes that medical schools have a responsibility to
educate their students about these promotional influences. "Medical
schools should consider restricting exposure to drug reps," he
Leana Wen, president of the American Medical Student Association
and a medical student at Washington University in St. Louis, agreed
that the influence of drug companies needs to be curbed.
"This is one of our key priorities," she said. "That is restoring
the professionalism back to medical education and practice."
"We think that big pharma has gotten intricately involved in
every aspect of medical education and clinical practice," Wen
said. "Medical schools really have a duty to educate students
about the proper ways to interact with drug companies."
Another expert was also disturbed by the study findings.
"Student behavior probably models the behavior of teachers by
whom they are taught," said Jan D. Carline, a professor of medical
education and biomedical informatics at the University of Washington.
"The behaviors of residents and faculty members continue to support
the acceptance of gifts."
The finding in the study that some students feel entitled to
gifts, "even though this entitlement is rationalized by debt and
overwork, is disturbing," he added.
"Medical schools need to address this and other issues of professional
behavior and ethics by looking towards the behaviors of the physicians
and the policies of their institutions," Carline said.
Two additional articles in the same issue of the journal highlight
other problems in the way doctors are being educated.
In one study, resident physicians said they were not prepared
to care for patients with specific cultural characteristics, such
as patients who have beliefs or practices at odds with Western
Another study found that residents who work long hours function
at a level comparable to having 0.04 to 0.05 grams percent blood
alcohol concentration, which can impair their abilities.
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