A new AAP policy statement and technical report aim to help clinicians recognize and guard against industry tactics to influence their choice of diagnostic and therapeutic options. Awareness of these marketing moves can help clinicians navigate relationships while prioritizing their primary responsibilities to patients and the public.
“I think most of us feel we’re smart enough to figure out when somebody’s selling us something — and we’re not prone to manipulation and influence — but the data show very clearly that’s not true,” said Douglas S. Diekema, M.D., M.P.H., FAAP, lead author of the policy and technical report and past chair of the Committee on Bioethics.
The policy and technical report, both titled Health Care Clinicians and Product Promotion by Industry, are available at https://doi.org/10.1542/peds.2022-056548 and https://doi.org/10.1542/peds.2022-056549. They will be published in the April issue of Pediatrics.
The policy acknowledges that pharmaceutical and medical device manufacturers need to collaborate with health care providers in the design, testing and manufacture of medical products. Research designed and funded by industry also is key in the development and improvement of therapeutic modalities. And industry interaction with physician experts and investigators remains essential throughout the development and research process.
But some interactions — even those that seem minor — can undermine a clinician’s ability to act in the patient’s best interest.
Financial inducements include honoraria, gifts, speaker fees, food, travel, lodging and educational and research grants. Deference, recognition, enhanced reputation and publication opportunities are examples of nonfinancial inducements.
“The primary challenge posed by interactions with industry is not one of health care providers who are corrupt, but of well-intentioned health care providers who are subtly and subconsciously influenced to make decisions that may not represent the best choice for their patients,” the policy states.
At a minimum, clinicians should be aware of methods that attempt to influence their behavior and develop strategies to address them.
Marketing extends beyond pitches from medical product sales representatives. It can include content presented in sponsored continuing medical education (CME) activities and offers of speaking, research and publishing opportunities.
Other types of promotional tactics can involve ghost-written articles and commentaries, and small research projects. Patient advisory groups and medical apps can be additional outlets for promotional messaging. Consulting opportunities might be marketing ploys if physicians hired as consultants are used to market a drug or other product.
Gifts, product samples
Evidence shows that gifts and product samples influence physician behaviors, including prescribing habits. Even modest gifts can have an effect because of the sense of obligation tied to their receipt.
The AAP advises health care clinicians to avoid any gift provided by an industry sponsor that sells a product within their prescribing realm. Yet many clinicians don’t believe they are vulnerable to these common techniques.
“Marketing is designed to engage our brains in ways we’re not even really aware of, to make us feel certain ways about products, and it has a much bigger influence on our behavior than we realize,” Dr. Diekema said.
A big driver in writing the policy was to make people aware of how easily they can be influenced by these methods, he added.
- Health care providers have a responsibility to educate themselves on the ways they are influenced by industry and strive to guard against those influences.
- Clinicians participating in industry-sponsored CME should recognize the potential marketing influences of these events.
- Clinicians should be aware that journal articles with industry sponsors or authors with conflicts of interest may be subject to biased reporting of data.
- Disclosure of conflicts of interest in education and research are essential but insufficient; they need to include precise descriptions of the industry relationship. Journal articles should report who funded a study, who planned and designed it, who controls the data, who wrote the first draft and whether final approval was required from an industry sponsor. Nonfinancial conflicts may warrant similar disclosure.
- Individuals on expert panels who help craft recommendations and authors of review articles in peer-reviewed journals ideally should have no financial relationships with entities that have a stake in the guidance. When reviewing the recommendations, clinicians should heed panel members’ conflicts of interest.
- Clinicians should refuse offers of ghost authorship.
The Open Payments program collects and publishes information about financial relationships between drug and device companies and health care providers, https://openpaymentsdata.cms.gov.