Physicians are systematically misled by industry-funded research, biased continuing medical education, and key opinion leaders on pharmaceutical payroll. The result is widespread prescription of ineffective or harmful treatments.

The Physician's Information Problem

Physicians are supposed to prescribe based on evidence. But the evidence they receive is systematically distorted:

  • Medical journals: Dominated by industry-funded research with positive publication bias
  • Continuing medical education: Largely funded by pharmaceutical companies
  • Drug representatives: Visit physicians with selective information and gifts
  • Key opinion leaders: Paid by companies to promote their products
  • Clinical guidelines: Often written by physicians with financial ties to industry

The CME Problem

Continuing medical education (CME) is required for physician licensure. In the United States, approximately 60% of CME is funded by pharmaceutical companies. Industry-funded CME consistently promotes industry products and increases prescribing of promoted drugs.

A 2010 study found that physicians who attended industry-funded CME were significantly more likely to prescribe the promoted drug, even when the drug was inferior to alternatives.

Physicians who attended industry-funded CME were significantly more likely to prescribe the promoted drug — even when the drug was inferior to alternatives.

The Drug Representative Problem

Pharmaceutical companies employ approximately 100,000 drug representatives in the United States — one for every 4-5 physicians. Drug representatives visit physicians with gifts, meals, and selective information about their products.

Studies consistently show that physician prescribing is influenced by drug representative visits, even when physicians believe they are not influenced. The influence is unconscious and difficult to resist.

The Key Opinion Leader System

Pharmaceutical companies identify influential physicians — key opinion leaders (KOLs) — and pay them to speak at conferences, write review articles, and consult for the company. KOLs are paid to promote company products and to create the impression of independent expert endorsement.

A 2007 investigation found that 94% of physicians had financial relationships with the pharmaceutical industry, including 28% who received payments for speaking or consulting.

What Physicians Can Do

Physicians who want to prescribe based on evidence should:

  • Rely on independently funded systematic reviews (Cochrane Collaboration)
  • Refuse to see drug representatives
  • Decline industry-funded CME
  • Disclose and minimize financial relationships with industry
  • Use independent prescribing information (e.g., Therapeutics Letter)