Intended for healthcare professionals


Drug company gifts to medical students: the hidden curriculum

BMJ 2013; 346 doi: (Published 20 February 2013) Cite this as: BMJ 2013;346:f1113

Re: Drug company gifts to medical students: the hidden curriculum

The exposure of medical students to marketing and gifts from pharmaceutical companies is an important issue that deserves more attention in medical education, and we welcome the contribution of King et al [1] to the evidence base on this. A systematic review on this subject by Austad et al, published in PLoS Medicine [2], acknowledges that very little data exists on the effect of student-industry interactions and recommends that “These results support future research into the association between exposure and attitudes, as well as any modifiable factors that contribute to attitudinal changes during medical education”.

It is notable that most studies have been conducted in the USA. This reflects the fact that medical students studying there are believed to have more exposure during their clinical training to all forms of marketing from pharmaceutical companies. This is in stark comparison to Europe, where there are more restrictions on such interactions. However, we feel that the dearth of evidence from Europe and the UK in particular reflects a dangerous complacency regarding the impacts on prescribing and attitudes of newly qualified doctors.

Anecdotally, our experience is that UK medical students are frequently exposed to marketing strategies [3], be it from lunches sponsored by drug companies to talks given at hospital grand rounds or GP teaching sessions. Medical schools in the UK have been slow to implement policies and specific undergraduate teaching addressing these issues and we are not aware of any medical school that has shown significant leadership in this area.

Moreover, it is disheartening to note that the Medical Schools Council is one of the organisations that remain signatory to a document ‘Guidance on collaboration between healthcare professionals and the pharmaceutical industry’ written by the Ethical Standards in Health and Life Sciences Group [4]. This document contains a number of spurious claims of important matters pertaining to patient safety, including some on the relationship between medical education and pharmaceutical companies. The document has been the focus of the recent Bad Guidelines campaign [5] and the Lancet has since been the only organisation to publicly remove its support for the guidance [6].

In the UK, PharmAware and the British Medical Association have been trying to address some of these problems. A motion proposed by PharmAware calling for a public policy on student interactions with pharmaceutical representatives with strict enforcement was accepted at the British Medical Association’s Annual Representatives’ meeting. This motion also acknowledged the harm caused by certain industry practices and mandated the BMA Medical Students’ Committee to provide clear guidance for medical students on the ethics of interactions between pharmaceutical representatives and the medical profession. However, as of yet, there has been no obvious action taken to implement the recommendations of this motion and many medical schools across the UK are still not regulating the amount of exposure medical students have during training.

PharmAware is currently conducting a survey of UK medical students based on the work of Sierles et al which we hope will provide useful data for understanding the influences on newly qualified doctors, and how we can change them for the better. In the meantime, as clear evidence on the effects of exposure to drug promotion amongst medical students is still lacking in the UK, we would argue that more measures ought to be put in place to regulate and restrict exposure during medical training.

[1] King M, Essick C, Bearman P, Ross JS. Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis. BMJ 2013;346:f264
[2]Austad KE, Avorn J, Kesselheim AS (2011) Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review. PLoS Med 8(5): e1001037. doi:10.1371/journal.pmed.1001037
[3]Hall, Beth. (@Bet_Hall). Bribery Act? @felyeung @PharmAware Jan 30, 2013, 9.50PM GMT. Tweet
[4] Ethical Standards in Health and Life Sciences Group. Guidance on collaboration between healthcare professionals and the pharmaceutical industry. Available at: Accessed on 26/2/13
[5] Bad Guidelines. Available at Accessed on 26/2/13
[6] Horton R. Falling out with Pharma. Lancet 2013;381, Issue 9864, Page 358

Competing interests: The authors are the national committee of PharmAware, an organisation of medical students affiliated with Medsin-UK. Our aim is promote ethical interactions between medical students and the pharmaceutical industry. PharmAware is heavily involved in the Bad Guidelines campaign. DC and EH are members of Health Action International Europe, an independent network working to improve access to, and the rational use of, essential medicines with evidence-based advocacy. EH is on the management committee of Healthy Skepticism-UK. An organisation that aims to improve health by reducing harm from inappropriate, misleading or unethical marketing of health products or services, especially misleading pharmaceutical promotion in the UK.

28 February 2013
David E Carroll
Medical Student
Elizabeth Hall, Hannah Barton, Nathan Cantley, Alice Clarke
Queen's University Belfast
University Road, Belfast