Study: Pre-med students often exposed to drug promotions

Most pre-medical students surveyed reported they had accepted or seen someone else accept handouts from pharmaceutical company representatives.

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A survey of pre-medical students has found that 71% either received or observed someone accepting gifts, meals, drug samples, or journal articles and promotional literature from pharmaceutical sales representatives. 

The finding by researchers at the University of Washington School of Medicine was published in the October issue of Family Medicine.

The findings raise concerns because such drug company promotions have been shown to be an effective way to lead physicians to adopt prescribing practices not supported by the best scientific evidence, said Dr. David Evans, a UW associate professor of family medicine and senior author of the paper. Toby Keys, a UW lecturer in family medicine, was lead author.

Reaching students before they even start medical school risks normalizing this conflict of interest, Evans said. 

pictures of David Evans and Toby Keys
David Evans, left, was senior author and Toby Keys was lead author of the paper.

“It has been well documented that such direct-to-physician marketing efforts lead physicians to prescribe more expensive medicines and potentially less efficacious medicines. Physicians think they’re immune to drug company promotions. But the data say they’re not, and there’s no reason to think pre-medical students would be any less susceptible.”

More than 72,000 pharmaceutical sales representatives work in the United States alone, according to a 2013 study by the Pew Charitable Trusts. On average, generalist physicians receive two visits a day from such salespersons. 

In the new study, the researchers surveyed 911 students who had been accepted but had not yet started at the 14 medical schools involved in the study. Students who reported that they had either received or observed someone receiving gifts, meals, drug samples, or an article from a pharmaceutical salesperson were asked about where this happened and how many times they accepted or saw someone accept such handouts. 

Of the 911 students, 646 (71%) had accepted or seen someone accept such gifts. Of these, 40% participated in or saw three or more instances of such exchanges. Of those who saw one or more such interactions: 34% saw someone accept a drug sample; 43%, an article; and 49%, a small meal or snack.

Twenty-six percent of those surveyed said they had accepted a gift themselves, such items as a pens, pen lights and notebooks; 25%, an article; 7%, a drug sample; and 34%, a small meal or snack. Only, one in three (29%) of the students surveyed said they had not accepted or seen someone accept such promotional handouts.

Most of those who had accepted or seen someone accept gifts said the exchanges occurred while they were “shadowing” practicing physicians (54%) or while they were working (50%). Many med schools encourage prospective students to follow or “shadow” a physician at work to learn about medical practices. Many students take jobs in hospitals and clinics to gain work experience that might improve their chances of acceptance into med schools.

“Shadowing is a good practice; it gives students a practical idea of what they’re getting into if they decide to go into medicine,” Evans said. He added, however, that med-school admissions committees must be aware that they are placing applicants in situations vulnerable to pharmaceutical sales efforts that pose ethical challenges for which they have not been prepared.

One way to address this issue, Evans said, would for med-school websites to advise applicants about how to consider relationships with pharmaceutical representatives, and to start discussions on these relations earlier in their medical training.

Medical associations should also discourage physicians from receiving visits from drug salespeople, particularly when students are in their clinics, he added. “The medical profession needs to disentangle itself from the pharmaceutical industry,” Evans said. “I think it’s happening, just slowly.”

Financial support for this study was provided by the Society of Teachers of Family Medicine Foundation Project Fund-Humanities and Ethics Collaborative.

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