Drug and medical device companies target next generation of physicians, put patients at risk, experts say

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From 2013 to 2024, U.S. physicians received $12.1 billion from industry. (Photo credit: iStock by Getty Images)

Drug and medical device companies are courting medical students and early-career clinicians with promotional activities that endanger patient health, experts say.

Consider: A report earlier this year shows that roughly three-quarters of cardiology fellows in the U.S. received payments from medical drug and device companies in the year before graduation, jumping to 88% in the first few years after graduation. For fellows in specialties that significantly rely on technology, the proportion was even higher—80% received payments before graduating, and 96% afterward.

“The [study] of cardiology fellows provides evidence of the early targeting of physicians by industry, which serves the strategic purpose of forming long-term relationships that will foster familiarity, uptake, and allegiance to their products,” say co-authors Dr. Alice Fabbri and Dr. Quinn Grundy in an editorial in The BMJ published in September. “Ultimately, these relationships threaten the sustainability of healthcare and expose patients to unnecessary risk or harm.”

A new report, co-authored by Grundy, also shows that the pharmaceutical industry is targeting social media users with subtle promotional activities, such as sponsored patient influencers and “help-seeking” treatment ads versus explicit brand name medication marketing. 

Industry-backed social media content often contains misleading and poor quality health information, the researchers found in a review of 45 studies. And much of it does not comply with ethical and regulatory guidelines, shows the study, led by Jessica Mor, a PhD Candidate within the Lawrence Bloomberg Faculty of Nursing at the University of Toronto.

“Evidence of harmful content and promotional activities that have become more covert and targeted suggests the need for regulatory development,” Mor and her colleagues say.

Together, these trends highlight the challenges of reining in pharmaceutical and medical device industry activities, researchers say—especially on digital platforms with instant, international reach.

Industry marketing impacts medical treatment, patient trust in care

From 2013 to 2024, U.S. physicians received $12.1 billion from industry, with more than half receiving at least one payment, according to a March 2024 review of the Open Payments database. 

Orthopedic (musculoskeletal) surgeons received the greatest sum at $1.36 billion, followed by neurologists (nervous system specialists). Psychiatrists (mental, emotional, and behavioral disorder doctors) received $1.32 billion, and cardiologists (heart and blood vessel specialists) nearly $1.3 billion.

The three drugs associated with the most payments were blood thinners Xarelto (about $176 million) and Eliquis (about $102 million), along with Humira (about $100 million), which is used to reduce inflammation. Medical devices associated with the most industry payments include the da Vinci Surgical System (about $307 million), a type of robotic technology that allows surgeons to conduct minimally invasive procedures. 

Health professionals often think that industry payments and marketing strategies do not affect their clinical decision-making, Fabbri and Grundy say. 

But a growing body of evidence shows that these kinds of payments, gifts, meals (even low-value meals), education programs, and other forms of sponsorship do affect decision-making. They also lead to the prescribing of brand-name medications, in larger volumes, and higher industry profits, as well as the use of devices such as stents.

Commercial influence undermines trust in health care and exposes patients to unnecessary risks or harms, including incorrect or inappropriate care, the authors say. Direct-to-physician marketing of opioids by drug companies in the U.S., for example, was associated with not only increased opioid prescribing rates but also elevated mortality from overdoses.

For trainees and early-career clinicians, exposure to industry influence comes at a pivotal time.

“Doctors in training might be particularly vulnerable to the effects of drug promotion as they are still developing a professional identity and forming their practice patterns,” say Fabbri and Grundy. “Thus, drug and device companies seek to cultivate familiarity and brand allegiance early and frequently through forms of sponsorship that do not always ‘feel’ like promotion such as sponsored education, presence of device representatives in clinical spaces, and payments for training or education.”

Similarly, previous studies show the pharmaceutical industry also views nurses, pharmacists, dieticians, and other non-physician clinicians as powerful and desirable partners, making them ‘‘soft targets’’ for marketing and vulnerable to the same conflicts of interest.

More action needed to restrict promotions, protect early-career clinicians and their future patients

The Association of American Medical Colleges (AAMC) among other organizations, has recommended that academic medical centers “prohibit the acceptance of any gifts from industry by physicians and other faculty, staff, students, and trainees of academic medical centers, whether on-site or off-site.” 

In addition, the involvement of students and trainees in individual meetings with pharmaceutical representatives “should occur only for educational purposes and only under the supervision of a faculty member,” an AAMC task force advised.

The International Federation of Medical Students’ Associations (IFMSA) has also demanded that universities implement conflict of interest policies and restrict industry marketing and the presence of industry representatives in learning environments.

Still, more action is needed to mitigate health harms due to industry influence and protect patients and the integrity of health care in the U.S. and globally, the researchers say. 

A 2021 systematic review found that both the prevalence and content of conflict-of-interest policies at medical schools and teaching hospitals still varied greatly across countries.

“If students are trained in environments that lack policies to regulate relationships with industry and witness their supervisors and teachers interacting with industry on a daily basis, they absorb and normalize this behavior,” say Fabbri and Grundy.

Their recommendations include:

Healthcare institutions, they conclude, “must acknowledge the extent of commercial influence in healthcare and the risk of patient harm and prioritize building health systems and practice environments that preserve the integrity and independence of all clinical decision making.”

References

Fabbri A, Grundy Q. Protecting early career physicians from commercial influence. BMJ. Published online September 9, 2024. doi:10.1136/bmj.q1939

Mor J, Kaur T, Menkes DB, Peter E, Grundy Q. Pharmaceutical industry promotional activities on social media: a scoping review. Journal of Pharmaceutical Health Services Research. 2024;15(4). doi:10.1093/jphsr/rmae022