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Industry support of physician education in the USA
  1. William Fleischman1,
  2. Joseph S Ross2
  1. 1Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr William Fleischman, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; wf3{at}

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Pharmaceutical and medical device manufacturers spend billions annually marketing to physicians in the form of food and beverages, gifts and educational materials, as well as for speaker and consulting fees, and funding for continuing medical education (CME) programmes. Industry payments to physicians may influence physician prescribing,1 and potentially even disease definitions,2 and can therefore influence health expenditures and the healthcare system at large.3 Details of these payments have recently come to light with the passage of the Sunshine Act within the 2010 Affordable Care Act in the USA, and the resulting Open Payments programme. The effects, ethics and need for disclosure of such ties have long been debated.4 ,5 In this article, we review the role that industry plays in the education of physicians, including analyses of initial data from the Open Payments programme, and we discuss current international transparency efforts, existing gaps in transparency of US industry–medicine relationships and potential additions and improvements to the data collected by the Open Payments programme and of its use.

Industry communication with physicians

Pharmaceutical and medical device manufacturers have a multitude of ways to communicate with physicians to make them aware of their products, provide prescribing and other medical product information, and engage in product promotion. Among the most effective methods is through industry representatives, also known as detailers, who customise their communications to each individual physician to promote their products, such as by invoking reciprocity through gifts and meals, fostering camaraderie through personal relationships, and even by using prescribing data to cultivate prescribing commitments.6 Perhaps the most common form of communication comes in the guise of ‘education’, whereby the industry representative visits a physician's office to discuss their company's products; such visits are frequently accompanied by free lunch for the physician and staff, as well as free journal article …

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  • Twitter Follow William Fleischman at @WillFleischman

  • Contributors WF conceptualised and drafted the manuscript. JSR helped conceptualise and edit the manuscript.

  • Disclaimer The opinions expressed in this article are the author's own and do not reflect the view of the Department of Health and Human Services, or of the USA government.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: WF serves as a volunteer researcher at the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Open Payments programme. This article was written by WF in his personal capacity. JSR receives support through Yale University from CMS to develop and maintain performance measures that are used for public reporting, from Medtronic and Johnson and Johnson to develop methods of clinical trial data sharing, from the Blue Cross Blue Shield Association (BCBSA) to better understand medical technology evidence generation, and from the Food and Drug Administration (FDA) to develop methods for postmarket surveillance of medical devices.

  • Ethics approval The Yale University Institutional Review Board approved this study and provided oversight.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Requests for the raw data as well as the statistical code can be made to the corresponding author at