Interaction of nurses, pharmacists, and other non-physician clinicians within pharmaceutical industry is common

Scrutiny of physician relationships with industry has culminated in passage of the US Physician Payments Sunshine Act (part of the Affordable Care Act), intended to bring greater transparency to such relationships. However, according to authors in this week's PLOS Medicine, interactions with industry of non-physician clinicians—Registered Nurses, advanced practice nurses with prescriptive authority, physicians' assistants, pharmacists, dieticians, and physical or occupational therapists—have not undergone the same scrutiny, although they may be involved in the same types of decision making as physicians. Quinn Grundy (Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco) and colleagues conducted the first (to their knowledge) systematic review of the evidence regarding interactions of non-physician clinicians with industry and beliefs regarding such interactions.

In a search of studies published in Medline and Web of Science through June 2013, the researchers identified 15 studies that met their inclusion criteria. Overall, non-physician clinicians reported meeting regularly with from the ; few had eliminated these meetings from their practice. The majority of sampled nurses, nurse practitioners, and Registered Nurses reported receiving gifts, food and beverages including sponsored lunch and dinner events. Non-physician clinicians reported frequent receipt of samples of pharmaceuticals and other medical products for patient use and they generally held favorable views of such samples. Large majorities of non-physician clinicians reported attending -sponsored educational events or receipt of industry-provided educational materials. Most non-physician clinicians across disciplines held favorable views of interactions with sales representatives and in general. A minority perceived that industry marketing influenced their own practice, but more felt their colleagues would be influenced. Preparation for industry interactions generally was not a part of professional training. In addition to the pharmaceutical industry, the infant formula industry targeted marketing efforts at non-physician clinicians.

The authors state, "The frequency of industry interactions and, despite clinician recognition of the potential for bias and conflict of interest, the common view of industry as at worst, a 'necessary evil', suggest that clinician-industry interactions are normalized in clinical practice settings." The authors acknowledge several limitations of their study, including that the studies were observational and of varying methodological rigor, thus the findings may not be generalizable, and given the types of studies the prevalence or frequency non-physician clinician-industry interactions could not be quantified.

In a related Perspective, James Yeh and Aaron Kesselheim (Harvard University, Boston, MA) state that while recent policy changes may have been successful in insulating more physicians from promotional interactions, "By contrast, the study from Grundy and colleagues shows that promotion to non-physician health care providers remains vibrant." They suggest that because current programs intended to provide transparency about the prevalence of pharmaceutical industry marketing may not reach the non-physician clinician population, institutional policies should be constructed to apply to all providers of patient care.

More information: Grundy Q, Bero L, Malone R (2013) Interactions between Non-Physician Clinicians and Industry: A Systematic Review. PLoS Med 10(11): e1001561. DOI: 10.1371/journal.pmed.1001561

Related Stories

Family doc finds mid-level providers increase revenue

date Nov 26, 2013

(HealthDay)—Hiring mid-levels—physicians assistants and nurse practitioners—can improve productivity, resulting in increased physician take-home pay, according to an article published Nov. 10 in Medical Ec ...

Recommended for you

Key to better sex ed: Focus on gender & power

date Apr 17, 2015

A new analysis by Population Council researcher Nicole Haberland provides powerful evidence that sexuality and HIV education programs addressing gender and power in intimate relationships are far more likely ...

Journal tackles aging policy issues raised by White House

date Apr 17, 2015

In anticipation of the forthcoming 2015 White House Conference on Aging (WHCoA), The Gerontological Society of America (GSA) has produced a special issue of The Gerontologist that outlines a vision for older adults' econom ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.