More than half of physicians (57%) who responded to a recent Medscape poll said they accepted meals or payments from a drug or device maker last year.

However, a substantial portion of physicians said meals and/or payments should never be acceptable, and they believe such actions always or often influence physician practice.

The poll was posted on September 4. It received responses from 382 physicians.

Answers varied widely among physicians on what is acceptable.

Responses show that 24% of physicians say they should never accept free meals from drug or device makers. When asked about payments instead of meals, 44% said such payments were never acceptable.

Answers varied greatly on what types of activities might warrant payment from industry.

Table. In General, for Which Types of Activities Should Physicians Accept Payments From Industry?

% Physician Agreement Consulting 57 Speeches 54 Research 63 Education 55 Money from royalties/investments 23 None of the above 15

Physicians early on in their career were most likely to say free meals from industry are acceptable. While 22% of those with 5 years or less of experience said they are acceptable, only 14% of those with more than 30 years' experience agreed.

Hospital policy also appears to be divided on the subject. Almost 1 in 5 physicians (18%) said they were unsure whether their hospital placed any restrictions on industry contributions, while 38% said there were hospital restrictions on meals and/or payments, and 44% said there were no restrictions on either.

Influence on Practice?

Physicians were also asked about the effect of free meals or industry payments on practice.

More than one third (37%) responded that they thought payments always or often influenced physician practice (6% said they never influence practice), and 27% said complimentary meals always or often did (12% said they never influence practice).

As Medscape Medical News has reported, studies have found associations between payments or meals from drug and device makers and changes in practice overall.

A study in JAMA Internal Medicine found that physicians who received even an industry-sponsored meal promoting a particular drug were more likely to prescribe the brand-name drug than a less expensive generic one.

Industry Payments to Physicians Over $9B in 2018

The poll followed a report from the Centers for Medicare & Medicaid Services (CMS) that found that pharmaceutical and medical device industry payments to physicians totalled $9.35 billion in 2018, $380 million more than in 2017 and $770 million more than in 2014, the first full year of payments listed on the CMS's Open Payments website.

The larger sums are going to fewer physicians. In total, 627,000 doctors were listed on the website for 2018, 11,000 fewer than in 2016.

A rheumatologist asked in the comments of the poll why industry influence is roundly considered negative.

He wrote, "Being influenced is not necessarily bad. Otherwise, what is the point of attending teaching conferences, reading journals, consulting colleagues, doing CME, etc? If you never change your mind at all, you are a rigid robot, not a human doctor, and a really outdated one at that."

Many responders to the poll say they used to accept payments but no longer do.

A family medicine physician in the United Kingdom wrote, "I have not received a meal from the pharmaceutical industry for over 20 years. I stopped as I decided it was immoral and might unduly influence my prescribing, even if it might only be subliminal."

Others say they continue to accept the offers. A surgeon in Cameroon said, "I accept the meals when I'm hungry and can't step out for lunch, but I don't let it influence my clinical decisions."

A US physician in addiction medicine considers it reimbursement. The physician wrote: "I used to go to dinner presentations and listen to lectures. I considered the dinner as a payment for my time. My wife was allowed to accompany me. Now spouses are not welcome. I am not willing to give up time from my family even if I am provided a meal for it."

An obstetrician-gynecologist in the United States said free meals, "which are frequently mediocre, to listen to discussions of new medications that may be beneficial to our patients are acceptable. You can also ignore everything they say and just eat an enjoyable meal with your peers."

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