Refuse to accept that

1. The Physician-Pharmaceutical Industry Relationship

4. Case It is a busy day in the office, but you have agreed to speak for a minute to a pharmaceutical representative who has stopped by to drop off some samples of a new quinolone antibiotic, called Ubiquinone. Knowing your interest in golf, he has brought you golf balls emblazoned with the letter “U,” and also invites you to a round of golf at the country club this weekend. Would you accept the golf balls? Would you accept the invitation? (From: “Really difficult Problems in Medical Ethics”)

5. Attitudes and Practices

7. Are gifts from pharmaceutical companies ethically problematic? A survey of physicians Arch Intern Med. 2003;163:2213-2218 P=.08 P=.04 P=.05 P=.88 P=.10 P=.34

9. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions Am J Med 2001;110:551

10. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions Practices Among Residents Who Consider Promotion Appropriate Am J Med 2001;110:551

11. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions Practices Among Respondents Who Consider Activity Inappropriate Am J Med 2001;110:551

12. Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical promotions Perceived influence of pharmaceutical reps on Prescribing Practices Am J Med 2001;110:551 P<.0001 “ You” “ Other Physicians”

14. Pharmaceutical Branding of Resident Physicians JAMA 2001;286:1024

15. Pharmaceutical Branding of Resident Physicians JAMA 2001;286:1024

16. Patient Attitudes

18. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts J Gen Int Med 1998;13:151 P<.004 for all except mug, p=.24)

19. A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts J Gen Int Med 1998;13:151 P<0.0001 for all except trip, p=0.0017

20. Professional Guidelines

29. “ That stuff doesn’t influence me at all. I don’t even know what drug is on my pen. I just go for the food.” --Fill in your name here?

30. Pharmaceutical industry Spending on Promotion

31. Promotional spending on prescription drugs, l996-2002 Source: NIHCM, 2001

32. Promotional spending on prescription drugs, 2002 Total spending: $21 billion Source: IMS Health

33. Direct to consumer advertising on prescription drugs,l996-2000 Source: NIHCM, 2001

34. Direct to consumer advertising spending in the U.S., 2000 Source: NIHCM, 2001

35. Comparison of median revenue dedicated to R&D, profits, and marketing/administration, Fortune 500 drug companies, 2000 (n=11) Source: Public Citizen, 2001

36. Main task of drug company employees, 2000 Source: PhRMA Industry Profile 2000; percentages calculated by Sager and Socolar

37. Drug company jobs in marketing and research, 1995-2000 Source: PhRMA Industry Profile 2000; percentages calculated by Sager and Socolar # Jobs

39. Fortune 500 drug company profitability compared to all other Fortune 500 companies, 2000 Source: Public Citizen, 2001

41. Sources of increased drug expenditures, 2000-2001 Source: NIHCM, 2002 Total increase: $22.5 billion 24% 39% 37%

42. “ Gifts are just a form of promotion or advertising, and advertising is a part of our society, like it or not.”

44. Conflict of interest Set of conditions in which judgement concerning a primary interest tends to be unduly influenced by a secondary interest. NEJM 1993;329:573-6

46. “ That stuff doesn’t influence me at all. I don’t even know what drug is on my pen. I just go for the food.” --Fill in your name here?

47. Should doctors be held to different (higher) standards?

48. The physician-patient relationship is a fiduciary relationship .

50. “ That stuff doesn’t influence me at all. I don’t even know what drug is on my pen. I just go for the food.” --Fill in your name here?

51. Influence

53. The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns Chest 1992;102:270

57. Scientific versus Commercial Sources of Influence Am J Med 1982;273:4

58. Scientific versus Commercial Sources of Influence Am J Med 1982;273:4

64. Physicians, Pharmaceutical Sales Representatives, and the Cost of Prescribing Arch of Fam Med 1996;5:237

66. Bias in promotional materials

69. Pharmaceutical Advertisements in Leading Medical Journals: Experts’ Assessments Ann Int Med 1992;116:912

72. Logical Fallacies in Pharmaceutical Promotion [Sample Ads available on request from No Free Lunch] JGIM, 1994; 9:563

80. The Academic-Industry Relationship

82. Scope and Impact of Financial Conflicts of Interest in Biomedical Research JAMA 2003;289:454

87. BMJ, 2002:325:249

89. Relationships between authors of clinical practice guidelines and the pharmaceutical industry JAMA 2002;287:612

90. Relationships between authors of clinical practice guidelines and the pharmaceutical industry JAMA 2002;287:612

91. Relationships between authors of clinical practice guidelines and the pharmaceutical industry JAMA 2002;287:612

95. Just say no to drug reps