“But Doctors do it…”: Nurses' Views of Gifts and Information from the Pharmaceutical Industry

Abstract

Spanish

French

Background

Most nurses, like their physician counterparts, lack education regarding pharmaceutical marketing strategies, and little is known of their beliefs and practices regarding this industry. Nurses are increasingly targeted by pharmaceutical companies as they become more involved in prescription and as policies restrict pharmaceutical companies' contact with physicians.

Objective

To assess nurses' beliefs and reported practices concerning pharmaceutical marketing and sponsorship strategies.

Methods

We conducted parallel Web- and paper-based surveys of a sample of senior registered nurses employed by government-funded health boards in 2 regions of New Zealand to explore their contact with the pharmaceutical industry as well as their beliefs and practices regarding information, gifts, and sponsorship provided by pharmaceutical companies. Returns were tested using Fisher's exact test to determine consistency in response between regions. Results for key outcome variables, including attitude toward the value of industry-derived information, were analyzed by region and in aggregate.

Results

Most nurses had contact with pharmaceutical sales representatives (69/106), accepted gifts from representatives (79/105), and believed information from the pharmaceutical industry probably improved their practice (71/106). Half believed that they would be able to detect misleading information if it were present, and 35% believed that accepting gifts and sponsorship was ethically acceptable. We found positive associations between the belief that information from the industry improved practice and reported acceptance of conference funding (OR 3.63; 95% CI 1.41 to 11.55), free food (OR 3.24; 95% CI 2.03 to 7.55), or gifts (OR 3.52; 95% CI 1.38 to 8.95). Nurses generally acknowledge the presence of pharmaceutical marketing in the hospital and the ethical challenges it presents; nonetheless, they also generally accept marketing gifts and may underestimate both the ethical challenges and their own susceptibility to persuasion.

Conclusions

Given the increasing role that nurses may play in pharmaceutical marketing strategy, the profession should consider its position vis-à-vis the industry.

Keywords

nursing pharmaceutical marketing

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References

Moynihan

Doran

Henry

. Disease mongering is now part of the global health debate. PLoS Med 2008;5: e106.

Moynihan

Henry

. The fight against disease mongering: generating knowledge for action. PLoS Med 2006;3: e191.

Mintzes

Barer

Kravitz

. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. CMAJ 2003;169:405–12.

Mahon

. Impact of direct-to-consumer advertising on healthcare providers and consumers. Clin J Oncol Nurs 2006;10:417–20.

Mansfield

Mintzes

Richards

Toop

. Direct to consumer advertising. BMJ 2005;330:5–6.

Mansfield

Mintzes

. Direct-to-consumer advertising is more profitable if it is misleading. N Z Med J 2003;116: U610.

Mintzes

Barer

Kravitz

. Influence of direct-to-consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ 2002;324:278–9.

Healy

. The latest mania: selling bipolar disorder. PLoS Med 2006;3: e185.

Wazana

. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000;283:373–80.

10.

Relman

. Separating continuing medical education from pharmaceutical marketing. JAMA 2001;285:2009–12.

11.

Smith

. Medical journals and pharmaceutical companies: uneasy bedfellows. BMJ 2003;326:1202–5.

12.

Smith

. Making progress with competing interests—still some way to go (editorial). BMJ 2002;325:1375–6.

13.

Baker

Johnsrud

Crismon

Rosenheck

Woods

. Quantitative analysis of sponsorship bias in economic studies of antidepressants. Br J Psychiatry 2003;183:498–506.

14.

Boyd

Bero

. Assessing faculty financial relationships with industry: a case study. JAMA 2000;284:2209–14.

15.

Lexchin

Bero

Djulbegovic

Clark

. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003;326:1167–76.

16.

Moncrieff

Hopker

Thomas

. Psychiatry and the pharmaceutical industry: who pays the piper? Psychiatr Bull R Coll Psychiatr 2005;29:84–5.

17.

Perlis

Hwang

Joseph

Nierenberg

. Industry sponsorship and financial conflict of interest in the reporting of clinical trials in psychiatry. Am J Psychiatry 2005;162:1957–60.

18.

Wager

. How to dance with porcupines: rules and guidelines on doctors' relations with drug companies. BMJ 2003;326:1196–8.

19.

G⊘tzsche

Hrobjartsson

Johansen

Haahr

Altman

Cha

A-W

. Ghost authorship in industry-initiated randomised trials. PLoS Med 2007;4: e19.

20.

Stanford University. Policy and guidelines for interactions between the Stanford University School of Medicine, the Stanford Hospital and Clinics, and Lucile Packard Children's Hospital with the pharmaceutical, biotech, medical device, and hospital and research equipment and supplies industries (“Industry”). 2006. http://med.stanford.edu/coi/siip/documents/siip_policy_aug06.pdf (accessed 2009 Feb 12).

21.

Geppert

. Medical education and the pharmaceutical industry: a review of ethical guidelines and their implications for psychiatric training. Acad Psychiatry 2007;31:32–9.

22.

Smith

. Conflicts of interest: how money clouds objectivity. J R Soc Med 2006;99:292–7.

23.

Ashmore

Carver

Banks

. Mental health nursing students' relationships with the pharmaceutical industry. Nurse Educ Today 2007;27:551–60.

24.

Civaner

Sarikaya

Alici

Bozkurt

. Exposing nursing students to the marketing methods of pharmaceutical companies. Nurs Ethics 2008;15:396–410.

25.

Monaghan

Galt

Turner

. Student understanding of the relationship between the health professions and the pharmaceutical industry. Teach Learn Med 2003;15:14–20.

26.

Viale

. Direct-to-consumer advertising of prescription medications: implications for patients with cancer. Oncol Nurs Forum 2002;29:505–13.

27.

Nolan

Carr

Doran

. Nurse prescribing: the experiences of psychiatric nurses in the United States. Nurs Stand 2004;18:33–8.

28.

Arnold

. The hidden prescribers. Med Mark Media 2004;39:44–52.

29.

Researched Medicines Industry Association of New Zealand Incorporated. Code of Practice. Wellington, NZ: 2006.

30.

Rogelberg

Stanton

. Introduction: understanding and dealing with organizational survey nonresponse. Organ Res Meth 2007;10:195–209.

31.

Zipkin

Steinman

. Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med 2005;20:777–86.

32.

Chew

O'young

Hazlet

Bradley

Maynard

Lessler

. A physician survey of the effect of drug sample availability on physicians' behavior. J Gen Intern Med 2000;15:478–83.

33.

Sagarin

Cialdini

Rice

Serna

. Dispelling the illusion of invulnerability: the motivations and mechanisms of resistance to persuasion. J Pers Soc Psychol 2002;83:526–41.

34.

Watkins

Kimberly

Jr. . What residents don't know about physician–pharmaceutical industry interactions. Acad Med 2004;79:432–7.

35.

Mansfield

. Is it insulting to suggest that health professionals are influenced by drug companies? Healthy Skepticism International News 2007;25:5.

36.

Jutel

Menkes

. Soft targets: nursing and the pharmaceutical industry. PLoS Med 2008;5: e5.

37.

deSilets

. Commercial support for professional development. J Contin Educ Nurs 2006;37:52–3.

38.

Jones

. Case report. Nurse prescribing: a case study in policy influence. J Nurs Manag 2004;12:266–72.

39.

Goodell

. Evidence, please. PLoS Med Responses 2008. www.plosmedicine.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2Fc76e997b-c220-493b-a535-914e3f1202dd&root=info%3Adoi%2F10.1371%2Fannotation%2Fc76e997b-c220-493b-a535-914e3f1202dd

40.

Steinman

Shlipak

McPhee

. Of principles and pens: attitudes and practices of medicine house staff toward pharmaceutical industry promotions. Am J Med 2001;110:551–7.

41.

Braithwaite

Emery

de Lusignana

Sutton

. Using the Internet to conduct surveys of health professionals: a valid alternative? Fam Pract 2003;20:545–51.

42.

Gore-Felton

Koopman

Bridges

Thoresen

Spiegel

. An example of maximizing survey return rates: methodological issues for health professionals. Eval Health Prof 2002;25:152–68.