Academic Psychiatry

, Volume 29, Issue 2, pp 222–229 | Cite as

The Role of the Pharmaceutical Industry in Teaching Psychopharmacology: A Growing Problem




To describe and examine the role of the pharmaceutical industry in the teaching of psychopharmacology to residents and medical students and to make recommendations for changes in curriculum and policy based on these findings.


Literature reviews and discussions with experts, educators, and trainees.


The pharmaceutical industry currently plays an extensive role in teaching psychopharmacology to trainees, both directly and indirectly. Attendance at industry-sponsored lectures and drug lunches, meetings with pharmaceutical representatives, and interactions involving the acceptance of various gifts are the most obvious venues. Less apparent but equally pervasive are the influence of industry-sponsored faculty and research and industry’s effect on the climate of practice and the profession as a whole. Replacing medical education with industry promotion in the guise of scholarship causes demonstrable harm to trainees, the public and the profession.


In light of these findings, the medical profession must reassert control of medical education and draw a firm barrier between commercial and professional pursuits. These issues must be actively, explicitly, and rigorously discussed with our colleagues and students.


Medical Student Medical Education Pharmaceutical Industry Academic Psychiatry Continue Medical Education 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Sigworth SK, Cohen GM: Pharmaceutical branding of resident physicians. JAMA 2001; 286: 1024–1025PubMedCrossRefGoogle Scholar
  2. 2.
    Bodenheimer T: Uneasy alliance- clinical investigators and the pharmaceutical industry. N Engl J Med 2000; 342: 1539–1544PubMedCrossRefGoogle Scholar
  3. 3.
    Angell M: Is academic medicine for sale? N Engl J Med 2000; 342: 1516–1518PubMedCrossRefGoogle Scholar
  4. 4.
    Relman A, Angell M: America’s other drug problem. The New Republic, 12/16/02:27-41Google Scholar
  5. 5.
    Public Citizen’s Congress Watch. 2002 Drug Industry Profits. Public Citizen, Washington, D.C. 2003Google Scholar
  6. 6.
    IMS Health Integrated Promotional Services and CMR, 2002 cited in Canadian Medical Association Journal 2003;169: 699Google Scholar
  7. 7.
    Kessler D, Rose J, Temple R, et al: Therapeutic class wars-drug promotion in a competitive marketplace. N Engl J Med 1994; 331: 1350–1353PubMedCrossRefGoogle Scholar
  8. 8.
    IMS World Pharmaceutical Market Summary 11/2003Google Scholar
  9. 9.
    Profiting from Pain: Where Prescription Drug Dollars Go Families USA Publication No. 02_105 7/17/2002Google Scholar
  10. 10.
    Wolfe SM: Why do American drug companies spend more than $12 billion a year pushing drugs? Is it education or promotion? J Gen Intern Med 1996; 11: 637–639PubMedCrossRefGoogle Scholar
  11. 11.
    Pharmaceutical Research and Manufacturers of America, Pharmaceutical Industry Profile, 2001, Wash: PhRMA, 2001, Appendix: Detailed Results from the Annual Survey, Table 18Google Scholar
  12. 12.
    Relman A: Separating continuing medical education from pharmaceutical marketing. JAMA 2001; 285: 2009–2014PubMedCrossRefGoogle Scholar
  13. 13.
    Public Citizen. Medical Education Services Suppliers: A threat to physician education. 7/19/2000
  14. 14.
    Elliott C: Pharma goes to the laundry: public relations and the business of medical education. Hastings Center Rep 2004; 34: 18–23CrossRefGoogle Scholar
  15. 15.
    Peterson M: Madison Ave. has growing role in the business of drug research. The New York Times, 11/22/02 pp A1, C4Google Scholar
  16. 16.
    Avorn J, Chen M, Hartley R: Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med 1982; 73: 4–8PubMedCrossRefGoogle Scholar
  17. 17.
    Prosser H, Almonda S, Walley T: Influence on GPs’ decision to prescribe new drugs-the importance of who says what. Fam Pract 2003; 20: 61–68PubMedCrossRefGoogle Scholar
  18. 18.
    Bowman M, Pearle D: Changes in drug prescribing patterns related to commercial company funding of continuing medical education. J Cont Educ in Health Prof 1988; 8: 13–20CrossRefGoogle Scholar
  19. 19.
    Orlowski J, Wateska L: The effects of pharmaceutical firm enticements on physician prescribing patterns. there’s no such thing as a free lunch. Chest 1992; 102: 270–273PubMedCrossRefGoogle Scholar
  20. 20.
    Chren M, Landefeld S: Physicians’ behavior and their interactions with drug companies: A controlled study of physicians who requested additions to a hospital drug formulary. JAMA 1994; 271: 684–689PubMedCrossRefGoogle Scholar
  21. 21.
    Tondo L, Hennen J, Baldessarini R: Lower suicide risk with long-term lithium treatment in major affective illness: A metaanalysis. Acta Psychiatr Scand 2001; 104: 163–172PubMedCrossRefGoogle Scholar
  22. 22.
    Lithium decline reflects economic, not clinical trends. Clinical Psychiatry News, Vol 29 #12, 12/01, pp1,9Google Scholar
  23. 23.
    Medawar C: The antidepressant web: marketing depression and making medicines work. Int J Risk & Safety in Med 1997; 10: 75–126Google Scholar
  24. 24.
    Rosencheck R, Perlick D, Bingham S, et al: Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia. A randomised controlled trial. JAMA 2003; 290: 2693–2702CrossRefGoogle Scholar
  25. 25.
    Healy D: Manufacturing Consensus, in Greenslit N (Ed.), Pharmaceutical Cultures: Marketing Drugs and Changing Lives in the U.S., Rutgers University Press (in press)Google Scholar
  26. 26.
    Wilkes M, Doblin B, Shapiro M: Pharmaceutical advertisements in leading medical journals: expert’s assessments. Ann Intern Med 1992; 116: 912–919PubMedCrossRefGoogle Scholar
  27. 27.
    Loke T, Koh F, Ward J: Pharmaceutical advertisement claims in australian medical publications. Is evidence accessible, compelling and communicated comprehensively? Med J Aust 2002; 177: 291–293PubMedGoogle Scholar
  28. 28.
    Stryer D, Bero L: Characteristics of materials distributed by drug companies. J Gen Int Med 1996; 11: 575–583CrossRefGoogle Scholar
  29. 29.
    Ziegler M, Lew P, Singer B: The accuracy of drug information from pharmaceutical sales representatives. JAMA 1995: 273; 1296–128PubMedCrossRefGoogle Scholar
  30. 30.
    Lexchin J: What information do physicians receive from pharmaceutical representatives? Can Fam Physician 1997; 43: 941–945PubMedCentralPubMedGoogle Scholar
  31. 31.
    Bowman M: The impact of drug company funding on the content of continuing medical education. Mobius 1986; 1: 133–136Google Scholar
  32. 32.
    Jackson T: Are you being duped? How drug companies use opinion leaders. BMJ 2001; 322: 1312CrossRefGoogle Scholar
  33. 33.
    Kjaergard LL, Als-Nielson B: Association between competing interests and authors’ conclusions: epidemiological study of randomised clinical trials published in the. BMJ BMJcom 2002; 325: 249–253CrossRefGoogle Scholar
  34. 34.
    Davidson RA: Source of funding and outcome of clinical trials. J Gen Intern Med 1986; 1: 155–158PubMedCrossRefGoogle Scholar
  35. 35.
    Lexchin J, Bero L, Djulbegovic B, et al: Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 2003; 326: 1167–1173PubMedCrossRefGoogle Scholar
  36. 36.
    Bekelman J, Li Y, Gross C: Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 2003; 289: 454–465PubMedCrossRefGoogle Scholar
  37. 37.
    Cho MK, Bero LA: The quality of drug studies published in symposium proceedings. Ann Intern Med 1996; 124: 485–489PubMedCrossRefGoogle Scholar
  38. 38.
    Bero L, Rennie D: Influences on the quality of published drug studies. Int J Technology Assessment in Health Care 1996; 12: 209–237CrossRefGoogle Scholar
  39. 39.
    Massie B, Rothenberg D: Publication of sponsored symposiums in medical journals. N Engl J Med 1993; 328: 1196–117PubMedCrossRefGoogle Scholar
  40. 40.
    Morgan S, Barer M, Evans R: Health economists meet the fourth tempter: drug dependency and scientific discourse. Health Econ 2000; 9: 659–667PubMedCrossRefGoogle Scholar
  41. 41.
    Freemantle N, Mason L, Young P: Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs: meta-regression analysis. Br J Psychiatr 2000; 177: 292–302CrossRefGoogle Scholar
  42. 42.
    Melander H, Ahlqvist-Rastad J, Meijer G, et al: Evidence b(i)ased medicine-selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003;326 1171–9PubMedCrossRefGoogle Scholar
  43. 43.
    Safer D: Design and reporting modifications in industry-sponsored comparative psychopharmacology trials. J Nerv Ment Dis 2002; 190: 583–592PubMedCrossRefGoogle Scholar
  44. 44.
    Schulman K, Seils M, Timbie J, et al: A national survey of provisions in clinical trial agreements between medical schools and industry sponsors. N Engl J Med 2002; 347: 1335–1341PubMedCrossRefGoogle Scholar
  45. 45.
    Flanagan A, Carey L, Fontanarosa P, et al: Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA 1998; 280: 222–224CrossRefGoogle Scholar
  46. 46.
    Rennie D, Flanagan A: Authorship! authorship! guests, ghosts, grafters, and the two-sided coin. JAMA 1994; 271: 469–471PubMedCrossRefGoogle Scholar
  47. 47.
    Healy D, Cattell D: Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatr 2003; 183: 22–27CrossRefGoogle Scholar
  48. 48.
    Choudhry N, Stelfox H, Detsky A: Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA 2002; 287: 612–617PubMedCrossRefGoogle Scholar
  49. 49.
    Lo B, Wolf L, Berkeley J: Conflict-of-interest policies for investigators in clinical trials. N Engl J Med 2000; 343: 1616–1620PubMedCrossRefGoogle Scholar
  50. 50.
    Van McCrary S, Anderson C, Jakovljevic J, et al: A national survey of policies on disclosure of conflicts of interest in biomedical research. N Engl J Med 2000; 343: 1621–165PubMedCrossRefGoogle Scholar
  51. 51.
    Whittington C, Kendall T, Fonagy P, et al: Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. The Lancet 2004; 363: 1341–1345CrossRefGoogle Scholar
  52. 52.
    Sandberg WS: The effect of educational gifts from pharmaceutical firms on medical students’ recall of company names or produces. Acad Med 1997; 72: 916–918PubMedCrossRefGoogle Scholar
  53. 53.
    Wazana A: Physicians and the pharmaceutical industry. Is a gift ever just a gift? JAMA 2000; 283: 373–380PubMedCrossRefGoogle Scholar
  54. 54.
    Monaghan M, Galt K, Turner P, et al: Student understanding of the relationship between the health professions and the pharmaceutical industry. Teaching and Learning in Med 2003; 15: 14–20CrossRefGoogle Scholar
  55. 55.
    Steinman M, Shlipak M, McPhee S: Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical sales representatives. Am J Med 2001; 110: 551–557PubMedCrossRefGoogle Scholar
  56. 56.
    Hodges B: Interactions with the pharmaceutical industry: experiences and attitudes of psychiatry residents, interns and clerks. Can Med Assoc J 1995; 153: 553–559Google Scholar
  57. 57.
    Bellin M, McCarthy S, Drevlow L, et al: Medical students’ exposure to pharmaceutical industry marketing: A survey at one U.S. medical school. Acad Med 2004; 79: 1041–1045PubMedCrossRefGoogle Scholar
  58. 58.
    Keim S, Sanders A, Witzke D, et al: Beliefs and practices of emergency medicine faculty and residents regarding professional interactions with the biomedical industry. Ann Emerg Med 1993; 22: 1576–1581PubMedCrossRefGoogle Scholar
  59. 59.
    McKinney W, Schiedermayer D, Lurie N, et al: Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives. JAMA 1990; 264: 1693–167PubMedCrossRefGoogle Scholar
  60. 60.
    Palmisano P, Edelstein J: Teaching drug promotion abuses to health profession students. J Med Educ 1980; 55: 453–455PubMedGoogle Scholar
  61. 61.
    American Medical Student Association’s PharmFree Medical Student Pledge ( Jan 22, 2001
  62. 62.
    Lichstein P, Turner R, O’Brien K: Impact of pharmaceutical company representatives on internal medicine residency programs. Arch Intern Med 1992; 152: 1009–1013PubMedCrossRefGoogle Scholar
  63. 63.
    Ludmerer K: Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford University Press 1999Google Scholar
  64. 64.
    Brodkey A, Sierles F, Spertus I, et al: Clerkship directors’ perceptions of the effects of managed care on medical students’ education. Acad Med 2002; 77: 1112–1120PubMedCrossRefGoogle Scholar
  65. 65.
    Relman A: Why Johnny Can’t Operate: The Collapse of Medical Education in America. The New Republic, 10/2/00:42Google Scholar
  66. 66.
    Chren M, Landefeld C: Doctors, drug companies, and gifts. JAMA 1989; 262: 3448–3451PubMedCrossRefGoogle Scholar
  67. 67.
    Rogers W, Mansfield P, Braunack-Mayer A, et al: The ethics of pharmaceutical industry relationships with medical students. Med J Australia 2004; 180: 411–414PubMedGoogle Scholar
  68. 68.
    Caudill T, Johnson M, Rich E, et al: Physicians, pharmaceutical sales representatives and the cost of prescribing. Arch Fam Med 1996; 5: 201–206PubMedCrossRefGoogle Scholar
  69. 69.
    Haayer F: Rational prescribing and sources of information. Soc Sci Med 1982; 16: 2017–2023PubMedCrossRefGoogle Scholar
  70. 70.
    Watkins C, Harvey I, Carthy P, et al: Attitudes and behaviour of general practitioners and their prescribing costs: a national cross sectional survey. Qual Saf Health Care 2003; 12: 29–34PubMedCrossRefGoogle Scholar
  71. 71.
    Caamanol F, Figueirasl A, Gestal-Oterol J: Influence of commercial information on prescription quantity in primary care. The Eur J Public Health 2002; 12: 187–191CrossRefGoogle Scholar
  72. 72.
    Galt K, Rich E, Kralewski J: Group practice strategies to manage pharmaceutical cost in an HMO network. Am J Managed Care 2001; 7: 1081–1090Google Scholar
  73. 73.
    Lasser K, Allen P, Woolhandler S, et al: Timing of new black box warnings and withdrawals for prescription medications. JAMA 2002; 287: 2215–2220PubMedCrossRefGoogle Scholar
  74. 74.
    Murray T, Campbell I: Finance, not learning needs, makes general practitioners attend courses: A database survey. Br Med J 1997; 315: 353CrossRefGoogle Scholar
  75. 75.
    Baird P: Funding medical and health related research in the public interest. Can Med Assoc J 1996; 155: 299–301Google Scholar
  76. 76.
    Tallon D, Chard J, Dieppe P: Relation between agendas of the research community and the research consumer. Lancet 2000; 355: 2037–2040PubMedCrossRefGoogle Scholar
  77. 77.
    Rothman D: Medical professionalism-focusing on the real issues. N Engl J Med 2000; 342: 1284–126PubMedCrossRefGoogle Scholar
  78. 78.
    Nathan D, Weatherall D: Academia and industry: lessons from the unfortunate events in toronto. The Lancet 1999; 353: 771–772CrossRefGoogle Scholar
  79. 79.
    Bitter Pill. The Guardian, 5/7/01Google Scholar
  80. 80.
    The Center for Science in the Public Interest maintains a searchable database on the financial ties of nonprofit groups and scientists to corporate sources at:
  81. 81.
    Blake RL, Early EK: Patients’ attitudes about gifts to physicians from pharmaceutical companies. J Am Board Fam Pract 1995; 8: 457–464PubMedGoogle Scholar
  82. 82.
    Gibbons R, Landry F, Blouch D, et al: A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts. J Gen Intern Med 1998; 13: 151–154PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Mainous A, Hueston W, Rich E: Patient perceptions of physician acceptance of gifts from the pharmaceutical industry. Arch Fam Med 1995; 4: 335–339PubMedCrossRefGoogle Scholar
  84. 84.
    Arthur Andersens of Medicine. Washington Post, 4/29/02, p. A21Google Scholar
  85. 85.
    Moynihan R, Health I, Henry D: Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324: 886–891PubMedCrossRefGoogle Scholar
  86. 86.
    No Free Golf. Time Online Edition accessed 11/5/02
  87. 87.
    Hospital, Drug Firm Relations Probed. Boston Globe, Business Section, p. A1, 6/29/03Google Scholar
  88. 88.
    Accreditation Council of Graduate Medical Education. Principles to Guide the Relationship between Graduate Medical Education and Industry. Washington, D.C: 9/10/02Google Scholar
  89. 89.
    Wazana A, Primeau F: Ethical considerations in the relationship between physicians and the pharmaceutical industry. Psychiatr Clin N Am 2002; 25: 647–663CrossRefGoogle Scholar
  90. 90.
    Self D, Baldwin D. Moral reasoning in medicine. In: Rest JR, Narvaez D, Eds. Moral Development in the Professions: Psychology and Applied Ethics. Hillsdale, N.J: Lawrence Erlbaum Associates;1994: 147–162Google Scholar
  91. 91.
    Wilkes M, Hoffman J: An innovative approach to educating medical students about pharmaceutical promotion. Acad Med 2001; 76: 1271–1277PubMedCrossRefGoogle Scholar
  92. 92.
    Hopper J, Speece M, Musial J: Effects of an educational intervention on residents’ knowledge and attitudes toward interactions with pharmaceutical representatives. J Gen Intern Med 1997; 12: 639–642PubMedCentralPubMedCrossRefGoogle Scholar
  93. 93.
    Shear N, Black F, Lexchin J: Examining the physician-detailer interaction. Can J Pharmacol 1996; 3: 175–179Google Scholar
  94. 94.
    Vinson DC, et al: Medical students’ attitudes toward pharmaceutical marketing: possibilities for change. Fam Med 1993; 25: 31–33PubMedGoogle Scholar
  95. 95.
    Shaugnessy A, Slawson D, Bennett J: Teaching information mastery: evaluating information provided by pharmaceutical representatives. Fam Med 1995; 27: 581–585Google Scholar
  96. 96.
    Agrawal S, Saluja I, Kaczorowski J: A prospective before-and-after trial of an educational intervention about pharmaceutical marketing. Acad Med 2004; 79: 1046–1050PubMedCrossRefGoogle Scholar
  97. 97.
    Education Council, Residency Training Programme in Internal Medicine, Dept. of Medicine, McMaster University, Hamilton, Ont. Development of residency program guidelines for interaction with the pharmaceutical industry. Can Med Assoc J: 1993; 149: 405–408Google Scholar
  98. 98.
    Brotzman G, Mark D: Policy recommendations for pharmaceutical representative-resident interactions. Fam Med 1992; 24: 431–432PubMedGoogle Scholar
  99. 99.
    Wazana A, Granich A, Primeau F, et al: Using the literature in developing mcgill’s guidelines for interactions between residents and the pharmaceutical industry. Acad Med 2004; 79: 1033–1040PubMedCrossRefGoogle Scholar
  100. 100.
    Brotzman G, Mark D: The effect on resident attitudes of regulatory policies regarding pharmaceutical representative activities. J Gen Intern Med 1993; 8: 130–134PubMedCrossRefGoogle Scholar
  101. 101.
    McCormick B, Tomlinson G, Brill-Edwards P, et al: Effect of restricting contact between pharmaceutical company representatives and internal medicine residents on posttraining attitudes and behavior. JAMA 2001; 286: 1994–199PubMedCrossRefGoogle Scholar
  102. 102.
    Wolfsthal S, Beasley B, Kopelman R, et al: Benchmarks of support in internal medicine residency training programs. Acad Med 2002; 77: 50–56PubMedCrossRefGoogle Scholar

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© Academic Psychiatry 2005

Authors and Affiliations

  1. 1.University of Pennsylvania Medical SchoolPhiladelphiaUSA

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