Most third-year medical students are regularly exposed to pharmaceutical marketing activities, but they don't believe the marketing will influence their future prescribing habits, according to a study in the Sept. 7 issue of the Journal of the American Medical Association.
The 826 students from eight medical schools who were surveyed in 2003 said they received an average of one gift or attended one pharmaceutical company-sponsored event a week. And more than 93% said they were asked or required by a physician to attend at least one sponsored lunch.
Most students considered themselves somewhat immune to marketing activities, as 68.8% of respondents said gifts would not influence their practices and 57.7% said they didn't believe their colleagues would be affected either.
"I think the essence of the study is that all of these problems associated with the receipt of gifts by physicians have all moved to early medical education," said the report's lead author, Frederick Sierles, M.D., professor and director of medical education in psychiatry and behavioral science at Rosalind Franklin University of Medicine and Science in North Chicago, Ill.
Sierles said most previous studies have focused on residents, and the few studies that looked at medical students were only single-school surveys. He said this was the first study to his knowledge that looked at how often students are required to attend sponsored events, student awareness of their school and medical society policies on receiving gifts, and their tendency to feel entitled to these gifts.
Of the 42.4% of the respondents who were AMA members, only 14% were familiar with the association's policy that drug-industry gifts should be of minimal value, be of benefit to patients and come with no strings attached. Of the 56.9% who belonged to the American Medical Student Association, only 12.6% were familiar with the AMSA's more stringent recommendations that physicians and students not accept any gifts from drug companies and that hospitals discontinue industry-sponsored education programs.
Not only were students unaware of policies discouraging the acceptance of gifts and meals, 80.3% of respondents felt entitled to receive them.
"I don't think I'm entitled to get gifts, but the feeling we get is that we do spend a lot of time talking to reps, so we're entitled to a lunch because our time is valuable," said Anna Litmanovich, a third-year medical student from Orange County, Calif., attending Rosalind Franklin. "We're poor medical students. So, if you feed us, we'll come and listen to you."
The study found that students recognized that industry-sponsored programs present slanted information. Although 89% of respondents said industry-sponsored grand rounds were educational and about 71% found drug-company materials to be a useful way of finding out about new drugs, 67.4% also said that they knew sponsored grand-round programs were biased.
"It's not subtle," Litmanovich said. "They give you a PowerPoint presentation on why their drug is better than anything else and they don't beat around the bush. They say, `You should be prescribing this drug.' "
The industry trade association Pharmaceutical Research and Manufacturers of America declined to comment on the study.
Litmanovich said she worries more about how students are bombarded with drug company logos everywhere they look. "It's advertising and it's all over the hospital," she said. "To say that we're not to be influenced is naive."
Sierles said that the "hidden curriculum" of medical school, which includes the socialization of young doctors that occurs when they observe attending physicians accepting industry gifts and meals, might be even more influential than drug-company marketing or school and medical-society policies.
"Students are invited into the world of prescribing physicians and residents and see what they do," he said. "They perceive that `This is part of the world around us,' but they're not told they have to be cautious. There are few rules that say `Don't do this.' So we have to teach them that skepticism is in order."