A systematic review of published studies reveals that undergraduate medical
students may experience substantial exposure to pharmaceutical marketing, and
that this contact may be associated with positive attitudes about marketing.
The relationship between health professionals and the pharmaceutical industry
has become a source of controversy. Physicians' attitudes towards the
industry can form early in their careers, but little is known about this key
stage of development.
Methods and Findings
We performed a systematic review reported according to PRISMA guidelines to
determine the frequency and nature of medical students' exposure to the
drug industry, as well as students' attitudes concerning pharmaceutical
policy issues. We searched MEDLINE, EMBASE, Web of Science, and ERIC from
the earliest available dates through May 2010, as well as bibliographies of
selected studies. We sought original studies that reported quantitative or
qualitative data about medical students' exposure to pharmaceutical
marketing, their attitudes about marketing practices, relationships with
industry, and related pharmaceutical policy issues. Studies were separated,
where possible, into those that addressed preclinical versus clinical
training, and were quality rated using a standard methodology. Thirty-two
studies met inclusion criteria. We found that 40%–100%
of medical students reported interacting with the pharmaceutical industry. A
substantial proportion of students (13%–69%) were
reported as believing that gifts from industry influence prescribing. Eight
studies reported a correlation between frequency of contact and favorable
attitudes toward industry interactions. Students were more approving of
gifts to physicians or medical students than to government officials.
Certain attitudes appeared to change during medical school, though a time
trend was not performed; for example, clinical students
(53%–71%) were more likely than preclinical students
(29%–62%) to report that promotional information helps
educate about new drugs.
Undergraduate medical education provides substantial contact with
pharmaceutical marketing, and the extent of such contact is associated with
positive attitudes about marketing and skepticism about negative
implications of these interactions. These results support future research
into the association between exposure and attitudes, as well as any
modifiable factors that contribute to attitudinal changes during medical
Please see later in the article for the Editors' Summary
The complex relationship between health professionals and the pharmaceutical
industry has long been a subject of discussion among physicians and
policymakers. There is a growing body of evidence that suggests that
physicians' interactions with pharmaceutical sales representatives may
influence clinical decision making in a way that is not always in the best
interests of individual patients, for example, encouraging the use of
expensive treatments that have no therapeutic advantage over less costly
alternatives. The pharmaceutical industry often uses physician education as
a marketing tool, as in the case of Continuing Medical Education courses
that are designed to drive prescribing practices.
One reason that physicians may be particularly susceptible to pharmaceutical
industry marketing messages is that doctors' attitudes towards the
pharmaceutical industry may form early in their careers. The socialization
effect of professional schooling is strong, and plays a lasting role in
shaping views and behaviors.
Why Was This Study Done?
Recently, particularly in the US, some medical schools have limited
students' and faculties' contact with industry, but some have
argued that these restrictions are detrimental to students' education.
Given the controversy over the pharmaceutical industry's role in
undergraduate medical training, consolidating current knowledge in this area
may be useful for setting priorities for changes to educational practices.
In this study, the researchers systematically examined studies of
pharmaceutical industry interactions with medical students and whether such
interactions influenced students' views on related topics.
What Did the Researchers Do and Find?
The researchers did a comprehensive literature search using appropriate
search terms for all relevant quantitative and qualitative studies published
before June 2010. Using strict inclusion criteria, the researchers then
selected 48 articles (from 1,603 abstracts) for full review and identified
32 eligible for analysis—giving a total of approximately 9,850 medical
students studying at 76 medical schools or hospitals.
Most students had some form of interaction with the pharmaceutical industry
but contact increased in the clinical years, with up to 90% of all
clinical students receiving some form of educational material. The highest
level of exposure occurred in the US. In most studies, the majority of
students in their clinical training years found it ethically permissible for
medical students to accept gifts from drug manufacturers, while a smaller
percentage of preclinical students reported such attitudes. Students
justified their entitlement to gifts by citing financial hardship or by
asserting that most other students accepted gifts. In addition, although
most students believed that education from industry sources is biased,
students variably reported that information obtained from industry sources
was useful and a valuable part of their education.
Almost two-thirds of students reported that they were immune to bias induced
by promotion, gifts, or interactions with sales representatives but also
reported that fellow medical students or doctors are influenced by such
encounters. Eight studies reported a relationship between exposure to the
pharmaceutical industry and positive attitudes about industry interactions
and marketing strategies (although not all included supportive statistical
data). Finally, student opinions were split on whether
physician–industry interactions should be regulated by medical schools
or the government.
What Do These Findings Mean?
This analysis shows that students are frequently exposed to pharmaceutical
marketing, even in the preclinical years, and that the extent of
students' contact with industry is generally associated with positive
attitudes about marketing and skepticism towards any negative implications
of interactions with industry. Therefore, strategies to educate students
about interactions with the pharmaceutical industry should directly address
widely held misconceptions about the effects of marketing and other biases
that can emerge from industry interactions. But education alone may be
insufficient. Institutional policies, such as rules regulating industry
interactions, can play an important role in shaping students'
attitudes, and interventions that decrease students' contact with
industry and eliminate gifts may have a positive effect on building the
skills that evidence-based medical practice requires. These changes can help
cultivate strong professional values and instill in students a respect for
scientific principles and critical evidence review that will later inform
clinical decision-making and prescribing practices.
Please access these Web sites via the online version of this summary at
Further information about the influence of the pharmaceutical
industry on doctors and medical students can be found at the
American Medical Students
Association PharmFree campaign and PharmFree Scorecard, Medsin-UKs PharmAware
campaign, the nonprofit organization Healthy
Skepticism, and the Web site of No