The relationship between doctors and pharma companies is the subject of intense scrutiny—there is widespread skepticism about the intent of industry and concern for the vulnerability of doctors in the relationship. Unfortunately, the debate on how pharma does not influence this relationship forward has become polarized: industry argues that collaboration with physicians is essential to scientific advancement, but at the same time many doctors are pledging to cut all their ties to drug companies. Whether physicians ought to interact with pharmaceutical sales representatives (reps) is a question worthy of careful ethical analysis. The issue presents a challenge to both professional integrity and time management.

Knowing that doctors turn to published literature and lectures to make their decisions, pharma provides grants to researchers and funds conferences. Accepting free drug samples is one of the more contested issues among doctors. While doctors may see this as an act of charity by pharma companies, which will benefit their patients living in poverty, it is actually just another way of increasing familiarity with drugs. When a doctor gives a patient a drug sample, she has to learn the name, dosing and side effects of the drug. Even though the sample is free at first, once a patient’s condition is well-controlled with this medication, the doctor is more likely to keep using this drug since it “already works for the patient.” She is also then more likely to prescribe it to other patients because she remembers the details of the drug. In a market where the newest drugs are usually just slight variations on existing products, this type of familiarity is essential to pharmaceutical sales.

It is then perhaps unsurprising to note that medical school provides substantial contact to students with pharmaceutical companies, and the more contact they have, the more likely they are to think that such pharma does not influence their prescribing behavior. In a study of medical residents, 61% felt their prescribing behavior was immune from drug promotions but interestingly, only 16% felt this way about the prescribing of other physicians. This means that doctors think they can’t be influenced, but obviously acknowledge that others can.

When it comes to the research, there is no question that doctors are in fact influenced. A review from 2010 finds that information provided by drug companies (drug reps, journal ads, pharma-sponsored events, participating in pharma-funded clinical trials and more) all led to an increase in prescribing the promoted drug.