Author Archives: Aaron Kesselheim

Does Pharmaceutical Industry Marketing to Medical Students Affect Their Prescribing Choices as Physicians?

Jun 28, 2011, 1:00 PM, Posted by Aaron Kesselheim

Aaron Kesselheim, M.D., J.D., M.P.H., is an assistant professor of medicine at Harvard Medical School and a primary care physician based in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital. He is a 2009 recipient of the Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

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As a physician who studies trends in drug prescribing and seeks to promote evidence-based medicine, I have always been intrigued by the paradox related to the impact of pharmaceutical marketing on physicians’ behavior. Physicians are highly educated, and that preparation is intended to impart special insight when it comes to the medical literature and evaluating the data underlying potential treatment decisions. It is perhaps not surprising, therefore, that when physicians are surveyed, most report that pharmaceutical marketing does not sway their individual prescribing choices. Yet most objective studies show that marketing does indeed drive prescribing in non-evidence-based ways. And physicians, when polled, will generally not deny this effect, although they usually point fingers at their colleagues, believing them to be influenced by marketing, while claiming that they personally are not.

What’s going on? In numerous cases, pharmaceutical industry marketing has been shown to rely on distorted presentations of the medical literature, and many advertising campaigns improperly favor use of the particular drug being promoted in order to sell more product. Yet most physicians take seriously their professional ethical requirements, and I don’t doubt that all physicians try to apply their years of training to offer the best care they can to their patients. If so, why are physicians as susceptible to marketing messages from the pharmaceutical industry as ordinary consumers are susceptible to marketing messages they see on television?

One possible contributing factor is the perspectives and practices formed early in physicians’ careers. The socialization effect of professional schooling can be strong, exerting a powerful influence on how students behave after graduation. It is well known that medical students are frequently exposed to pharmaceutical marketing, even in their preclinical years. Some policymakers dismiss the relevance of these interactions; after all, medical students cannot prescribe drugs, so the potential for direct harm is limited. And medical students are often deeply in debt, and thus many sorely need the free supplies and books that might be distributed to them by pharmaceutical manufacturers.

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