A national survey of U.S. family medicine residency programs finds that most limit pharmaceutical and other industry interactions with residents while many exclude all interactions. The results, published in the May issue of Academic Medicine, suggest a major shift away from acceptance of food, gifts, samples, and industry-supported events. The survey was a joint effort between Georgetown University Medical Center and the American Medical Student Association (AMSA).
There are more than 400 accredited family medicine residency programs in the country responsible for training family medicine physicians. Previous studies suggest that almost all physicians-in-training (medical students and residents) have interacted in some way with pharmaceutical, medical device or biotechnology companies. Research shows that interactions - meeting with representatives; accepting gifts, food, and samples; and sponsored talks - between industry and trainees, as they develop their practice habits - affect prescribing patterns.
"There isn't any evidence that pharmaceutical representatives provide objective information to trainees," says Adriane Fugh-Berman, M.D., a professor of pharmacology at Georgetown University Medical Center. "To the contrary, studies have shown that the information they provide favors targeted drugs and that many assertions reps make are inconsistent with FDA-approved prescribing information."
In 2008, study authors sent our a four-question survey to the directors or coordinators of all 460 accredited family medicine residency programs.
The survey comprised the following questions:
- Does the residency allow gifts from industry or industry-supported food?
- Are drug samples accepted?
- Are industry representatives allowed access to medical students and/or residents at the family medicine center?
- Are any industry-sponsored residency activities allowed?
More than half (62.2 percent) of the programs submitted a response. Among responding family medicine residency programs, 52.1 percent reported that they refused drug samples, 48.6 percent disallowed industry gifts or food, 68.5 percent did not allow industry-sponsored residency activities, and 44.1 percent denied industry access to students and residents at the family medicine center.
Seventy-five residencies (26.2 percent) were designated as "pharma-free," meaning they didn't allow any of the activities described.
"Family medicine is leading the way in closing the door on pharma," Fugh-Berman says. "We were surprised that so many residencies were refusing all industry perks." She adds that a 1992 study found that 90 percent of family medicine residencies allowed industry support.
"Our survey allowed for comments so we know that some residency programs report recent changes in plans or practices to limit industry interaction. Although some faculty and some residents are opposed to these limits, it's clear that industry influence on family medicine residencies is waning."
The study's authors concluded that industry interactions can have adverse effects on rational prescribing and residency programs should assess the benefits and harms of these relationships.
Fugh-Berman is director of PharmedOut and serves as a paid expert witness on behalf of plaintiffs in litigation regarding pharmaceutical marketing practices. Based at Georgetown University Medical Center, PharmedOut is a project of volunteer students and health professionals who promote evidence-based prescribing, educate health care professionals about pharmaceutical marketing practices, and provide access to unbiased information about medications.
This work received no funding. PharmedOut donated pizza for volunteers and the AMSA donated postage for mailing. The authors report having no personal financial interests related to the study.
Georgetown University Medical Center