Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians' attitudes and prescribing habits: a systematic review

BMJ Open. 2017 Sep 27;7(9):e016408. doi: 10.1136/bmjopen-2017-016408.


Objectives: The objective of this review is to explore interactions between physicians and the pharmaceutical industry including sales representatives and their impact on physicians' attitude and prescribing habits.

Data sources: PubMed, Embase, Cochrane Library and Google scholar electronic databases were searched from 1992 to August 2016 using free-text words and medical subject headings relevant to the topic.

Study selection: Studies included cross-sectional studies, cohort studies, randomised trials and survey designs. Studies with narrative reviews, case reports, opinion polls and letters to the editor were excluded from data synthesis.

Data extraction: Two reviewers independently extracted the data. Data on study design, study year, country, participant characteristics, setting and number of participants were collected.

Data synthesis: Pharmaceutical industry and pharmaceutical sales representative (PSR) interactions influence physicians' attitudes and their prescribing behaviour and increase the number of formulary addition requests for the company's drug.

Conclusion: Physician-pharmaceutical industry and its sales representative's interactions and acceptance of gifts from the company's PSRs have been found to affect physicians' prescribing behaviour and are likely to contribute to irrational prescribing of the company's drug. Therefore, intervention in the form of policy implementation and education about the implications of these interactions is needed.

Keywords: attitude of health personnel; brand prescriptions; conflict of interest; gifts to physicians; irrational prescriptions; medical education; pharmaceutical industry; pharmaceutical sales representative; physicians, drug industry; physicians-industry interactions.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Attitude of Health Personnel*
  • Conflict of Interest*
  • Drug Industry / ethics*
  • Gift Giving / ethics
  • Humans
  • Interprofessional Relations / ethics
  • Policy
  • Practice Patterns, Physicians' / ethics
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Randomized Controlled Trials as Topic