Special article| Volume 110, ISSUE 7, P551-557, May 2001

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Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions

  • Michael A. Steinman
    Requests for reprints should be addressed to Michael Steinman, MD, VA Box 111G, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, California 94121; tel: (415) 750-6626; fax: (415) 750-6641
    VA National Quality Scholars Program (MAS), San Francisco, California, USA
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  • Michael G. Shlipak
    Division of General Internal Medicine (MGS), San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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  • Stephen J. McPhee
    Division of General Internal Medicine (MGS), San Francisco Veterans Affairs Medical Center, San Francisco, California, USA

    Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (MAS, SJM), San Francisco, California, USA
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      PURPOSE: Little is known about the factors that influence housestaff attitudes toward pharmaceutical industry promotions or, how such attitudes correlate with physician behaviors. We studied these attitudes and practices among internal medicine housestaff.
      SUBJECTS AND METHODS: Confidential surveys about attitudes and behaviors toward industry gifts were distributed to 1st- and 2nd-year residents at a university-based internal medicine residency program.
      RESULTS: Ninety percent of the residents (105 of 117) completed the survey. A majority of respondents considered seven of nine types of promotions appropriate. Residents judged the appropriateness of promotions on the basis of their cost (median percentage of items considered appropriate 100% for inexpensive items vs. 60% for expensive ones) more than on the basis of their educational value (80% for educational items vs. 75% for noneducational ones; P <.001 for comparison of appropriateness based on cost vs. educational value). Behaviors were often inconsistent with attitudes; every resident who considered conference lunches (n = 13) and pens (n = 18) inappropriate had accepted these gifts. Most respondents (61%) stated that industry promotions and contacts did not influence their own prescribing, but only 16% believed other physicians were similarly unaffected (P <.0001). Nonetheless, more than two thirds of residents agreed that it is appropriate for a medical institution to have rules on industry interactions with residents and faculty.
      CONCLUSIONS: Residents hold generally positive attitudes toward gifts from industry, believe they are not influenced by them, and report behaviors that are often inconsistent with their attitudes. Thoughtful education and policy programs may help residents learn to critically appraise these gifts.
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