For the past few years, one of the more contentious controversies has been the close financial ties between drugmakers and some doctors. But why have some docs embraced the pharmaceutical industry? Were their attitudes formed early in their careers? If so, would there be virtue in educating medical students and residents about the downside to industry interactions?
That is the conclusion reached in a report issued last week in PLoS Medicine, which analyzed 32 studies that looked at industry interactions with medical students and whether these influenced student views (this amounted to reviewing data concerning some 9,850 students at 76 med schools or hospitals). They found that most had some interaction with drugmakers, but contact increased in the clinical years, with up to 90 percent of all clinical students receiving some form of educational material.
What else did they find? In most studies, the majority of students in clinical training believed there was nothing wrong with taking gifts; a smaller percentage of preclinical students felt the same way. Why? They cited financial hardship or claimed other students did so anyway. While acknowledging education provided by industry is biased, most found the info to be useful. Almost two-thirds insisted they were not swayed by goodies or interaction with reps, but maintained others were not immune.
They were also divided on whether interactions should be regulated by med schools or the government. But 86 percent of American medical students reported that during their residencies they would like to interact with sales reps. At the same time, between 69 percent and 77 percent endorsed the idea that faculty should disclose any conflicts prior to lecturing.
Interestingly, most students reported they did not feel adequately educated about interactions with industry; between 62 percent and 86 percent wanted more instruction about this issue, the authors wrtie. Although 39 percent of the clinical students reported being adequately educated on the topic, only 11 percent of preclinical students reported the amount of instruction they received was sufficient.
Consequently, the authors write there is a "significant hole in the existing research, most notably the need for studies that can determine whether changes in student attitudes" toward drugmakers are caused by contact with "industry, the influence of role models, institutional policies, or other factors." And while a recent survey by the American Medical Student Association found that med schools have strong conflict policies (see here), they argue for developing strategies to educate students on industry interactions to address "misconceptions about the effects of marketing and other biases that can emerge from industry interactions."
"Given the pervasiveness of interactions between practicing physicians and drug, device, and other health care-related industries, it seems reasonable to formally teach medical students about the positive and negative issues surrounding these interactions," Aaron Kesselheim, a co-author and an assistant professor of pharmacoepidemiology and pharmaeconomics at Harvard Medical School, writes us.
One route he suggests is for schools to create mentors. "Mentoring definitely has an impact on professionalism development during medical school. It is part of what is classically called the 'hidden curriculum' of professional schools that impacts students' development," he continues. "Medical schools need to pay closer attention to how institutional policies (such as COI disclosure, attitudes towards consulting arrangements, etc.) affect the social context in which their medical students learn."