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Slide Shows (return to section menu)
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The Physician-Pharma Relationship
PharmedOut Grand Rounds Presentation (open access)
Links only work in slideshow view.
- References
Handout (text only--no graphics)
Learning Objectives (pre-post test available upon request)
Pharmaceutical Company Control of the Information Environment Downloadable slide show
Persuading Prescribers Wilson Lectureship given by Dr. Fugh-Berman in Albuquerque on September 29, 2006.
New Drugs from Old: Drug and Therapeutics Bulletin, Vol 44 No. 10 Oct 2006 presented at the Medical Journal Club, Morriston Hospital by Scott Pegler, Pharmacist at the National Health Service (UK) on November 20, 2006.
Separating the Wheat From the Chaff: Obtaining Useful Information from Pharmaceutical Representatives David C. Slawson and Allen F. Shaughnessy. From the University of Virginia and Tufts University Two-Day Information Mastery Course, module 12. University of Virginia Health System, Department of Family Medicine
Patient Information(return to section menu)
No Drug Reps Certificate (pdf)
Fast Facts on Generic Drugs Information for patients.
Help Your Doctor Break the Sample Habit
Unbiased Resources Drugs and other therapies.
Books (return to section menu)
Abramson, John. Overdo$ed America: the broken promise of American medicine. New York, NY. Harper Collins, 2004.
Angell, Marcia. The truth about the drug companies: how they deceive us and what to do about it. New York, NY. Random House, 2004.
Avorn, Jerry. Powerful medicines: the benefits, risks, and costs of prescription drugs. New York, NY. Knopf, 2004.
Brody, Howard. Hooked: ethics, the medical profession, and the pharmaceutical industry. New York, NY. Rowan and Littlefield Publishers, Inc., 2007.
Brownlee, Shannon. Overtreated: why too much medicine is making us sicker and poorer. New York, NY. Bloomsbury, 2007.
Critser, Greg. Generation Rx: how prescription drugs are altering American lives, minds, and bodies. Mariner Books, 2007.
Elliott, Carl. Better than well: American medicine meets the American dream. New York, NY. W.W. Norton, 2003.
Fox, Stephen R. The mirror makers: a history of American advertising and its creators. New York, NY. Morrow, 1984.
Goozner, Merrill. The $800 million pill: the truth behind the cost of new drugs. Berkeley, CA. University of California Press, 2004.
Greene, Jeremy A. Prescribing by numbers: drugs and the definition of disease. Baltimore, MD. The Johns Hopkins University Press, 2006.
Healy, David. The antidepressant era. Cambridge, MA. Harvard University Press, 1997.
Healy, David. Let them eat Prozac: the unhealthy relationship between the pharmaceutical industry and depression. New York, NY. New York University Press, 2004.
Kassirer, Jerome P. On the take: how America's complicity with big business can endanger your health. New York, NY. Oxford University Press, 2005.
Kilbourne, Jean. Can't buy my love: how advertising changes the way we think and feel. New York, NY. Simon & Schuster, 1999.
Kilbourne, Jean. Deadly persuasion: why women and girls must fight the addictive power of advertising. New York, NY. Free Press, 1999.
Moynihan, Ray. Selling sickness: how the world's biggest pharmaceutical companies are turning us all into patients. New York, NY. Nation Books, 2005.
Mundy, Alicia. Dispensing with the truth: the victims, the drug companies, and the dramatic story behind the battle over Fen-Phen. New York, NY. St. Martin's Press, 2001.
Payer, Lynn. Medicine and culture: varieties of treatment in the United States, England, West Germany, and France. New York, NY. Henry Holt and Company, 1996.
Reidy, Jamie. Hard sell: the evolution of a Viagra salesman. Kansas City, MO. Andrews McMeel, 2005.
Washburn, Jennifer. University, Inc.: the corporate corruption of American higher education. New York, NY. Basic Books, 2005.
Subscribables (return to section menu)
Morbidity and Mortality Weekly Report (MMWR) Free subscription to the electronic version of this CDC report
FDA MEDWATCH Contains warning letters about drugs and instructions on how to report an adverse event. Join the e-mail list.
FDA Drug Safety Newsletter (subscribe) Provides postmarketing information to healthcare professionals on new drug safety information and adverse events.
Therapeutics Letter Independent publication on rational drug therapy published by the Department of Pharmacology and Therapeutics at the University of British Columbia.
Australian Prescriber Independent review of drugs and therapeutics published by the National Prescribing Service.
MeReC Rapid Review (free subscription) Appraises new findings in the context of the current evidence base and healthcare practice. Recent reports:
World Health Organization Essential Drugs Monitor Information on national drug policies, current pharmaceutical issues, and rational drug use.
WHO Pharmaceuticals Newsletter Information on the safety and efficacy of pharmaceutical products. For a free subscription, email listserv@who.int with the following message text: "subscribe WHO-PHN."
Center for Science in the Public Interest (CSPI) Integrity in Science Project A conflict-of-interest database that includes individuals and groups. A CSPI listserve provides weekly information about conflicts of interest in science. Subscribe to the CSPI listserve.Articles (return to section menu)
Conflict of Interest
Direct to Consumer (DTC) Promotion
Disease Mongering
Docs and Pharma
Drug Promotion
Drug Reps
Drug Risks
Industry Sponsored Research
Media
Samples
Conflict of Interest
Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002;287:612-7.
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Yank V, Rennie D, Bero LA. Financial ties and concordance between results and conclusions in meta-analyses: retrospective cohort study. BMJ 2007;335:1202-5.
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Dominick L. Frosch DL, Krueger PM, Hornik RC, Cronholm PF, Barg FK. Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising. Ann Fam Med 2007;5(1):6-13.
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Kravitz RL, Epstein RM, Feldman MD, Franz CE, Azari R, Wilkes MS, Hinton L, Franks P. Influence of patients' requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA. 2005 Apr 27;293(16):1995-2002.
Abstract Full Text (free, but must sign in)
Zachry WM 3rd, Shepherd MD, Hinich MJ, Wilson JP, Brown CM, Lawson KA. Relationship between direct-to-consumer advertising and physician diagnosing and prescribing. Am J Health Syst Pharm. 2002 Jan 1;59(1):42-9.
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Marshall J and Aldhous P. Patient groups special: swallowing the best advice? New Sci. 2006 Oct 27;2575:18-22.
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Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ. 2002 Apr 13;324(7342):886-91.
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Moynihan R. Henry D. The fight against disease mongering: generating knowledge for action. PloS Med. 2006 Apr 3(4):e191. Epub 2006 Apr 11.
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Campbell E, Gruen R, Mountford J, et. al. A national survey of physician–industry relationships. NEJM 2007 Apr 26;356(17):1742-50.
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Carroll AE, Vreeman RC, Buddenbaum J, Inui TS. To what extent do educational interventions impact medical trainees' attitudes and behaviors regarding industry-trainee and industry-physician relationships? Pediatrics 2007;120:e1528-35.
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Lexchin J. Of Money and trust in medical care. The Academia-Industry Symposium MSM 2007: Medical Practice and the Pharmaceutical Industry and ever the duo shall meet. MSM 2007 Jan-Dec;5:7-10.
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Mansfield P, Lexchin J, Wen L, Grandori L, McCoy C, Hoffman J, et. al. Educating health professionals about drug and device promotion: advocates’ recommendations. PLoS Med. 2006 November;3(11):1988-1991.
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Mather C. The pipeline and the porcupine: alternate metaphors of the physician-industry relationship. Soc Sci Med. 2005 Mar;60(6):1323-34.
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Oldani MJ. Thick prescriptions: toward an interpretation of pharmaceutical sales practices. Med Anthropol Q. 2004 Sep;18(3):325-56.
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Ross J, Lackner J, Lurie P, et. al. Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota. JAMA 2007 Mar 21;297(11):1216-1222.
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Segovis CM, Mueller PS, Rethlefsen ML, et al. If you feed them, they will come: a prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center. BMC Med Educ 2007;7:22.
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Sierles FS, Brodkey AC, Cleary LM, et al. Medical students' exposure to and attitudes about drug company interactions: a national survey. JAMA 2005;294:1034-42.
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Greene JA. Pharmaceutical marketing research and the prescribing physician. Ann Intern Med 2007;146:742-8.
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Chimonas S, Brennan T, Rothman D. Physicians and drug representatives: exploring the dynamics of the relationship. JGIM 2007 Feb;22(2): 184–190
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Fugh-Berman A, Ahari S. Following the script: how drug reps make friends and influence doctors. PLoS Med 2007 Apr 24; 4(4): e150.
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Pegler S and Underhill J. Evaluating promotional material from industry: an evidence-based approach. The Pharmaceutical Journal. 2005 March 5;274(7339): 271-274.
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Shaughnessy AF, Slawson DC, Bennett JH. Teaching information mastery: evaluating information provided by pharmaceutical representatives. Fam Med. 1995 Oct;27(9):581-5.
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Shaughnessy AF, Slawson DC, Bennett JH. Separating the wheat from the chaff: identifying fallacies in pharmaceutical promotion. J Gen Intern Med. 1994 Oct;9(10):563-8.
Full Text (see Module 12)
Steinman M, Harper, M, Chren M, et. al. Characteristics and impact of drug detailing for gabapentin. PLoS Med 2007 Apr 24;4(4): e134.
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Zipkin DA, Steinman MA. Interactions between pharmaceutical representatives and doctors in training. A thematic review. J Gen Intern Med. 2005 Aug;20(8):777-86.
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Kesselheim AS, Avorn J. The role of litigation in defining drug risks. JAMA 2007 Jan 17;297(3):308-311.
Full Text (free, but must sign in)
Krumholz HM, Ross JS, Presler AH, Egilman, DS. What have we learnt from Vioxx? BMJ 2007 Jan;334(7585):120-123.
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Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the Food and Drug Administration, 1998-2005. Arch Intern Med 2007;167:1752-9.
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Als-Nielsen B, Chen W, Gluud C, Kjaergard LL. Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events? JAMA 2003;290(7):921-8.
Abstract Full Text (free, but must sign in)
Ashar BH, Miller RG, Getz KJ, Powe NR. Prevalence and determinants of physician participation in conducting pharmaceutical-sponsored clinical trials and lectures. J Gen Intern Med 2004;19:1140-5.
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Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003;326:1167-70.
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Melander H, Ahlqvist-Rastad J, Meijer G, Beermann B. Evidence b(i)ased medicine--selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ. 2003;326:1171-3.
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Shah, AA and Thomas FE. Commercial influence on psychiatric drug studies. Psychiatric Times. 2006 May; 71-73.
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Sismondo S. How pharmaceutical industry funding affects trial outcomes: Causal structures and responses. Soc Sci Med 2008;66:1909-14.
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Sismondo S. Pharmaceutical company funding and its consequences: A qualitative systematic review. Contemp Clin Trials 2008;29:109-13.
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Moynihan R, Bero L, Ross-Degnan D, Henry D, Lee K, Watkins J, Mah C, Soumerai SB. Coverage by the news media of the benefits and risks of medications. N Engl J Med. 2000 Jun 1;342(22):1645-50.
Abstract Full Text (free, but must sign in)
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Adair RF, Holmgren LR. Do drug samples influence resident prescribing behavior? A randomized trial.Am J Med. 2005 Aug;118(8):881-4.
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Boltri JM, Gordon ER, Vogel RL. Effect of antihypertensive samples on physician prescribing patterns. Fam Med 2002;34:729-31.
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Groves KEM, Sketris I, Tett SE. Prescription drug samples--does this marketing strategy counteract policies for quality use of medicines? J Clin Pharm Ther 2003;28:259-71.
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Reports (return to section menu)
Consumer Reports Best Buy Drugs A public information project administered by Consumers Union.
Report of the AAMC Task Force on Industry Funding of Medical Education to the AAMC Executive Council
COI in medical education.
American Medical Student Association (AMSA) PharmFree Scorecard 2008 Conflict of interest policies at academic medical centers.
Summary of Pharmaceutical Marketing Expenditures in the District of Columbia, Calendar Year 2006
AHRQ Compendia for Coverage of Off-Label Uses of Drugs and Biologics in an Anticancer Chemotherapeutic Regimen A review of drug compendia.
Lifting the Veil of Secrecy: Corporate Support for Health and Environmental Professional Associations, Charities, and Industry Front Groups. A 2003 report from Center for Science in the Public Interest (CSPI)
Drug promotion: what we know, what we have yet to learn: Reviews of materials in the WHO/HAI database on drug promotion EDM Research Series no. 32 (102 pages)More at WHO site Selection and Rational Use of Medicines. Norris P, Herxheimer A, Lexchin J, Mansfield P. World Health Organization (WHO) and Health Action International (HAI), 2004.
(Free paper copy available on request from WHO: e-mail edmdoccentre@who.int)
Educational Initiatives For Medical and Pharmacy Students About Drug Promotion: an International Cross-sectional Survey (pdf 3.75 MB) Mintzes B. World Health Organization (WHO) and Health Action International (HAI), 2005. Free paper copy also available on request from WHO: e-mail edmdoccentre@who.int
Blurring the Boundaries. Mintzes B. Health Action International (HAI).
Branding the Cure. Consumers International.
Turning Medicine Into Snake Oil: How Pharmaceutical Marketers Put Patients At Risk. New Jersey Public Interest Research Group Law and Policy Center. May 2006.
Getting Doctors to Say Yes to Drugs: The Cost and Quality Impact of Drug Company Marketing to Physicians. Blue Cross Blue Shield Association. Millenson, ML. Accessed September 2, 2006.
Profiting from Pain: Where Prescription Dollars Go. July 2002. Families USA Publication 02-105. More at Families USA Prescription Drug Publications.
Big Pharma Behaving Badly: A Survey of Selected Class Action Lawsuits Against Drug Companies, Fourth Edition. January 2005. Prepared for Families USA by Patrick Cafferty, Miller Faucher, and Cafferty, LLP. More at Families USA Prescription Drug Publications.
CSE’s White Paper on Promoting Integrity in Scientific Journal Publications. Editorial Policy Committee (2005-2006), Council of Science Editors (CSE). 2006.
Kaiser Family Foundation National Survey of Physicians Part II: Doctors and Prescription Drugs, March 2002. Additional Findings were released in 2006.
Kaiser Family Foundation Prescription Drug Trends Fact Sheet.
US Preventive Services Task Force (USPSTF) Guide to Clinical Practice for 2006. Free in pdf, print, or downloadable PDA format.
New drug treatment reports from the U.K. National Prescribing Center (part of the National Health Service)
Databases (return to section menu)
WHO Drug Promotion A World Health Organization database that contains more than 2000 abstracts from 1970-2002.
Conflict-of-Interest Database Center for Science in the Public Interest (CSPI) Integrity in Science database includes conflict of interest information on individuals and organizations.
No Free Lunch Provider Database Directory of health care providers who refuse pharma gifts and info.
Minnesota Board of Pharmacy Payments to Practitioners Documents
Drug Industry Document Archive (DIDA) Searchable database of internal industry documents and other papers concerning the marketing of Neurontin (gabapentin); also documents on the marketing of Vioxx (rofecoxib) from public records.
The Centers for Reviews Dissemination Primarily funded by the National Health Service (U.K.), the CDRD includes the Database of Abstracts of Reviews of Effects (DARE) which contains abstracts of systematic reviews and meta-analyses.
Websites/Organizations (return to section menu)
Therapeutics Initiative “provides physicians and pharmacists with up to date, evidence based, practical information on rational drug therapy” and publishes the Therapeutic Letter, a freely available, independent publication on rational drug therapy.
RxFacts Independent Drug Information Service Objective drug information. Clinical topics include:
Agency for Health Care Research and Quality (AHRQ) Evidence reports and research reviews on various diseases and conditions.
Office of Medical Applications of Research (OMAR), National Institutes of Health (NIH) lists NIH State-of-the-Science Consensus Statements.
National Cancer Institute (NCI) Information on cancer treatments for health care professionals and consumers.
Food and Drug Administration (FDA) Center for Drug Evaluation and Research (CDER)
Specific drugs at the FDA
Guidances the FDA’s current thinking on various topics
The National Institute for Health and Clinical Excellence (NICE) Independent organization in the U.K. that provides national guidance on the promotion of good health and the prevention and treatment of ill health.
Oxford Center for Evidence-Based Medicine. Lots of learning and teaching tools, including glossaries of terms and slideshows on Teaching Evidence Based Health Care; Graphical Appraisal Tool for Epidemiology; Implementing Evidence Based Practices; Statistics in Homeopathic Doses and Teaching about Diagnosis.
The Centers for Disease Control and Prevention (CDC) provides statistics, publications, and additional information on disease conditions. Morbidity and Mortality Weekly Report (MMWR) (free subscription)
National Center for Health Statistics (NCHS) contains reports and data on national and local health statistics.
World Health Organization (WHO) the United Nations health agency has extensive publications and resources on international health, specific diseases, and drug information.
James Lind Library Great information on evidence-based medicine; for example, see fair tests of therapies. Also contains historical documents.
National Electronic Library for Health (NeLH) provides access to MeReC, Drug and Therapeutics Bulletin, Bandolier, and other sites. Some resources (Cochrane reviews) are available only in the U.K.
The Cochrane Collaboration Systematic reviews of hundreds of medical therapies. Full reviews require subscription, but abstracts are free.
The Centers for Reviews Dissemination Primarily funded by the National Health Service (U.K.), the CDRD includes the Database of Abstracts of Reviews of Effects (DARE) which contains abstracts of systematic reviews and meta-analyses.
peRx (Prescribing Evidence-based Therapies) offers a documentary, information, and educational modules on the drug approval process, marketing strategies, ethical dimensions, and strategies to improve prescribing.National Physicians Alliance Founded by former leaders of AMSA, the NPA seeks "to restore physicians' primary emphasis on the core values of our profession: service, integrity, and advocacy...and to ensure equitable, affordable, high quality health care for all people."
No Free Lunch “Just say no to drug reps.” Physicians and medical students who “believe that pharmaceutical promotion should not guide clinical practice.” Information, news, resources, and essays; NFL also invented the “Pen Amnesty” program.
Healthy Skepticism An international non-profit organization that “aims to improve health by reducing harm from misleading drug promotion.” The site contains a web library of over 7300 items. Adwatch analyzes selected drug ads.
Health Care Renewal Summaries, commentary and links to news stories about integrity in science and medicine, drug promotion, institutional and corporate scandals.
Center for Science in the Public Interest (CSPI) Integrity in Science Project A conflict-of-interest database that includes individuals and groups. A CSPI listserve provides weekly information about conflicts of interest in science. Subscribe to the CSPI listserve.
American Medical Student Association (AMSA) and the AMSA Pharm-Free campaign Information on “counterdetailing” for medical students.
Includes sources of independent information on drugs, slideshows, and downloadable stickers used to cover up drug company logos.
Demanding Evidence, Foregoing Industry Bias (De-Fib) New site from University of Rochester medical students.
Health Action International: An international group that “works to increase access and improve the rational use of essential medicines.”
Center for Public Integrity produces investigative reports on issues of public concern. The project Pushing Prescriptions explores the political influence of the pharmaceutical industry.
Blogs (return to section menu)
Other Materials (return to section menu)
Unbiased Resources Drugs and other therapies.
Fast Facts on Generic Drugs Information for patients.
Drug Ad Bingo An exercise for physicians-in-training on how to recognize sales techniques in pharmaceutical ads.
An Introduction to Information Mastery (powerpoint) Mark H. Ebell, Department of Family Practice, College of Human Medicine, Michigan State University. A course on Information Mastery, Evidence-Based Medicine, and critical appraisal of the medical literature.
Selected documents on the marketing of Vioxx, for a Congressional hearing held on May 05, 2005 by the Committee on Government Reform, Minority Office, on The roles of the FDA and pharmaceutical companies in ensuring the safety of approved drugs, like Vioxx
Food and Drug Administration (FDA) Guidance for Industry on Industry-Supported Scientific and Educational Activities. Federal Register / Vol. 62, No. 232 / Wednesday, December 3, 1997 / Notices/64093. Additional Guidances from CDER.
Office of the Inspector General has the OIG Compliance Program Guidance for Pharmaceutical Manufacturers. Federal Register / Vol. 68, No. 86 / Monday, May 5, 2003 / Notices / 23731.
Our Videos
Pharma Insider II
Opposition research
(read transcript)
Pharma Insider I
Off-label promotion under the radar
(read transcript)
The Art of Medical Writing
Pharma's anonymous writers
Drug Reps Talk Shop II
Drug reps continue their chat
Drug Reps Talk Shop I Selling drugs to docs
Director of PharmedOut Explains the Project
Zyprexa Drug Rep Tells All Shahram Ahari describes how he sold the drug
News
Drugs to Build Bones May Weaken Them
Long-term bisphosphonates associated with transverse fracture NYT
Genentech Ends Midstage Studies of an Avastin Drug Combination
Sutent addition causes hemolytic anemia AP
Grassley Targets Brown’s Keller Over Grants
Advocated Paxil for adolescents Pharmalot
Vermont Doctors Collect Millions from Drug Firms
Psychiatrists head the list Burlington Free Press (read VT AG report)
Drug Industry to Announce Revised Code on Marketing
Bans the pens, keeps the food NYT (read PhRMA press release; WSJ blog)
Psychiatric Group Faces Scrutiny Over Drug Industry Ties
30% of APA's funding from pharma NYT
Follow-up Drug Studies are Becoming More Routine
Postmarketing studies required for 75% of new drugs Boston Globe
Brazil Launches Cheap New Malaria Pill
Patent-free treatment Windsor Star
Pill-popping Pets
Reconcile, Clonicalm, and other drugs NYT
Eli Lilly Most Esteemed Pharma Company for Psychiatrists
Verispan finds Pfizer most esteemed overall MM&M
Drugmakers Offer Aid To People 'On the Edge'
Needymeds site underutilized WP
Commentary
Deceptive Market Practices in the Marketplace of Ideas
“Think tanks” distorting health care debate Bioethics Forum
Click HERE to read the entire news archives
Department of Physiology and Biophysics * Box 571460 * Washington, DC 20057-1460