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From an editorial in JAMA:
We believe is it unjust to have a system in which patients pay for gifts that benefits doctors and drug companies.... As one of our British colleagues so aptly observed... 'We are being given a meal which many of our patients [who are paying for it in the United States] could not afford but which they would appreciate much more.'[796]
I have never seen a single doctor refuse a corporate gift. Social pressure may be part of the reason. Quoting from the journal Chest, "Doctors who do not eat drug company lunches are thought odd or unsociable."[797]
Eighty-five percent of U.S. residency training programs allow drug lunches.[798] A study in the Archives of Internal Medicine found that the catered noon conference has become a part of the culture of residency programs and that funding these conferences provided, "a major inroad for pharmaceutical companies." Forty percent of residency directors in the study agreed that, "Curtailing pharmaceutical company representative interactions with residents would jeopardize pharmaceutical company sponsorship of other departmental activities...." There was also a unanimous perception among internal medicine residency program directors that attendance at conferences would decrease without food provided by drug reps.[799]
The preponderance of financial support from the drug industry not surprisingly affects content. "If I came up with a really neat program about something physicians really need to know about, such as death and dying or the ethics of managed care - try and conduct it," writes the continuing medical education director at Wayne State Medical School. "You can't. Because you can't get commercial support for it."[800]
The meals are often accompanied by presentations espousing that company's latest line of drugs. Physicians probably don't expect that drug reps will openly contradict the drug package insert or literature available during a presentation, but in fact one JAMA study showed that 11% of the statements made by pharmaceutical representatives about drugs contradicted information readily available to them. Any surprise that all of the inaccurate statements were favorable toward the promoted drug? And not one of the false statements made during these presentations was questioned.[801]
[796] Chren, M, S Landefel and TH Murray. "Doctors, Drug Companies and Gifts." Journal of the American Medical Association 262(1989):3448-3451.
[797] Rosener, F. "Ethical Relationships between Drug Companies and the Medical Profession." Chest 102(1992):266.
[798] Ziegler, MG, P Lew and BC Singer. "The Accuracy of Drug Information Form Pharmaceutical Sales Representatives." Journal of the American Medical Association 273(1995):1296-1298.
[799] Lichstein, PR, Turner, RC and K O'Brien. "Impact of Pharmaceutical Company Representatives on Internal Medicine Residency Programs." Archives of Internal Medicine 152(1992):1009-1013.
[800] Gianelli, DM. "Revisiting the Ethics of Industry Gifts." American Medical News:1998(August 24-31):9, 12-14.
[801] Ziegler, MG, P Lew and BC Singer. "The Accuracy of Drug Information Form Pharmaceutical Sales Representatives." Journal of the American Medical Association 273(1995):1296-1298.