Medical students' exposure to and attitudes about the pharmaceutical industry: a systematic review.
Medical students' exposure to and attitudes about the pharmaceutical industry: a systematic review.
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DOI：
10.1371/journal.pmed.1001037
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发表时间：
2011-05
期刊：
影响因子：
15.8
通讯作者：
Kesselheim AS
中科院分区：
文献类型：
--
作者：
Austad KE;Avorn J;Kesselheim AS
对已发表研究的系统回顾表明，医科本科学生可能会大量接触到药品营销，这种接触可能与对营销的积极态度有关。卫生专业人员和制药工业之间的关系已经成为争议的来源。医生对这个行业的态度可能在他们职业生涯的早期就形成了，但人们对这个关键的发展阶段知之甚少。我们根据PRISMA指南进行了系统评价，以确定医学生接触药品行业的频率和性质，以及学生对药品政策问题的态度。我们搜索了MEDLINE、EMBASE、Web of Science和ERIC，从最早的可用日期到2010年5月，以及选定研究的参考书目。我们寻找原创性研究，这些研究报告了医学生接触制药营销的定量或定性数据、他们对营销行为的态度、与行业的关系以及相关的制药政策问题。在可能的情况下，将研究分为临床前培训和临床培训，并使用标准方法对质量进行评级。32项研究符合纳入标准。我们发现40%-100%的医科学生报告与制药行业有过互动。据报道，相当大比例的学生（13%-69%）认为来自行业的礼物会影响处方。八项研究报告了接触频率与对行业互动的有利态度之间的相关性。与政府官员相比，学生们更赞成送给医生或医学生的礼物。在医学院期间，某些态度似乎发生了变化，尽管没有表现出时间趋势；例如，临床专业的学生（53%-71%）比临床预科专业的学生（29%-62%）更有可能报告说，促销信息有助于了解新药。本科医学教育提供了与药品营销的大量接触，这种接触的程度与对营销的积极态度和对这些互动的负面影响的怀疑有关。这些结果支持未来对暴露和态度之间关系的研究，以及在医学教育期间导致态度改变的任何可修改因素。长期以来，卫生专业人员与制药业之间的复杂关系一直是医生和决策者讨论的主题。越来越多的证据表明，医生与药品销售代表的互动可能会以一种并不总是符合患者个人最佳利益的方式影响临床决策，例如，鼓励使用与成本较低的替代方案相比没有治疗优势的昂贵治疗方法。制药行业经常将医师教育作为一种营销工具，例如旨在推动处方实践的继续医学教育课程。医生可能特别容易受到制药行业营销信息影响的一个原因是，医生对制药行业的态度可能在他们职业生涯的早期就形成了。职业教育的社会化效应很强，对观念和行为的形成具有持久的影响。最近，特别是在美国，一些医学院限制了学生和教师与工业界的接触，但一些人认为这些限制不利于学生的教育。鉴于制药行业在本科医学培训中的作用存在争议，巩固这一领域的现有知识可能有助于确定教育实践变化的优先顺序。在本研究中，研究者系统地考察了制药行业与医学生互动的研究，以及这种互动是否影响了学生对相关话题的看法。研究人员对2010年6月之前发表的所有相关的定量和定性研究进行了全面的文献检索。使用严格的纳入标准，研究人员随后从1603篇摘要中选择了48篇文章进行全面审查，并确定了32篇符合分析条件的文章——总共有大约9850名在76所医学院或医院学习的医科学生。大多数学生与制药行业有某种形式的互动，但在临床年份接触增加，高达90%的临床学生接受某种形式的教育材料。暴露程度最高的是美国。在大多数研究中，大多数临床培训期间的学生认为医学生接受药品制造商的礼物在道德上是允许的，而一小部分临床前学生报告了这种态度。学生们以经济困难为理由，或声称大多数其他学生都接受了礼物，以此来为自己获得礼物的权利辩护。此外，尽管大多数学生认为来自行业来源的教育是有偏见的，但学生们不同地报告说，从行业来源获得的信息是有用的，是他们教育中有价值的一部分。近三分之二的学生报告说，他们不受促销、礼物或与销售代表互动引起的偏见的影响，但也报告说，其他医科学生或医生也会受到这种接触的影响。八项研究报告了接触制药业与对行业互动和营销策略的积极态度之间的关系（尽管并非所有研究都包括支持性的统计数据）。最后，学生们在医生与行业的互动是否应该由医学院或政府来监管的问题上存在分歧。这一分析表明，即使在临床前几年，学生也经常接触到制药营销，并且学生与行业接触的程度通常与对营销的积极态度和对与行业互动的任何负面影响的怀疑有关。因此，教育学生与制药行业互动的策略应该直接解决关于营销效果的广泛误解和行业互动中可能出现的其他偏见。但仅靠教育可能是不够的。制度政策，如规范行业互动的规则，可以在塑造学生的态度方面发挥重要作用，减少学生与行业接触和取消礼物的干预措施可能对培养循证医学实践所需的技能产生积极影响。这些改变有助于培养强大的专业价值观，并向学生灌输对科学原则和批判性证据审查的尊重，这些将为临床决策和处方实践提供信息。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1001037访问这些网站。关于制药业对医生和医学生的影响的更多信息，可以在美国医学生协会PharmFree运动和PharmFree记分卡、medin - uk PharmAware运动、非营利组织健康怀疑主义和No Free Lunch网站上找到。
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. 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 education. 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. 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. 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. 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 http://dx.doi.org/10.1371/journal.pmed.1001037. 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 Free Lunch.
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DOI：
10.1001/archfami.5.4.201
发表时间：
1996-04-01
期刊：
ARCHIVES OF FAMILY MEDICINE
影响因子：
--
作者：
Caudill, TS;Johnson, MS;McKinney, WP
通讯作者：
McKinney, WP
影响因子：
7.4
作者：
Bellin, M;McCarthy, S;Pierach, C
通讯作者：
Pierach, C
影响因子：
120.7
作者：
CHREN, MM;LANDEFELD, CS
通讯作者：
LANDEFELD, CS
影响因子：
5.9
作者：
Barry, D;Cyran, E;Anderson, RJ
通讯作者：
Anderson, RJ
影响因子：
5.9
作者：
AVORN, J;CHEN, M;HARTLEY, R
通讯作者：
HARTLEY, R