1. Sidiqi, Sarah RN, BSN

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Currently, there is controversy over the degree to which health care providers are connected to the pharmaceutical industry and its sales force. Pharmaceutical companies spend billions of dollars each year promoting and marketing their products. 1 A fraction of that amount, yet still estimated in the thousands (i.e., $8,000), is spent each year on individual physicians. Research has demonstrated that gifts from pharmaceutical companies to physicians lead to increased costs or negative health outcomes. 1


Furthermore, the pharmaceutical industry is closely intertwined with continuing medical education 2,3 and the development of clinical practice guidelines. 4 Interactions between pharmaceutical sales representatives and physicians have shown to impact physician prescribing patterns. 1,5


Unfortunately, there is a gap in the literature regarding the pharmaceutical industry's influence on nurse practitioner (NP) prescribing patterns. However, it is likely that pharmaceutical companies do influence NPs' prescribing practices. Much of NPs' prescription writing is invisible, and difficult to track, thereby making it difficult to assess the degree to which pharmaceutical companies affect NPs' prescriptions. 6


NPs must examine this issue on both a personal and professional level to develop safeguards against inappropriately prescribing medications under biased influences. Reviewing and understanding the stances some physicians have taken on this issue may help NPs enact safeguards. However, we must examine our role as NPs, and the varied attributes as well as challenges that our role might bring in amending this problem.


Amending this issue is one way for NPs to become visible. All NPs should use individualized prescription pads that identify them as NPs and list only name and license or other required identifier. 7 Pharmacists will then be required to enter accurate prescribing data into their databases, which will aid in identifying NP-specific prescribing patterns. Unfortunately, there are "supervisory states" in which NPs are not permitted to use individualized prescription pads. 7 NP advocacy at a policy level will hopefully help to allow appropriate NP recognition in all states.


Some physicians conclude that medical schools should adopt formal rules prohibiting all gifts from drug companies to students. They argue that these rules would help dispel the conflict of interest that may result from such gifts. 8


Should NP programs adopt similar rules? Several medical professional societies have developed guidelines to modulate the interaction between physicians and the pharmaceutical industry. However, awareness of the guidelines for physicians is lacking. 1 Perhaps professional nursing organizations should adopt similar guidelines and/or nurses should help publicize the existing guidelines.


On an individual level, NPs should be sure that they are able to critically analyze research data. Advance practice nurses should be educated and sophisticated consumers of research, and also have the ability to conduct research. 9 This will help NPs critically examine the research presented by drug companies and determine the efficacy of various pharmaceuticals.


Additionally, once educated about pharmaceutical research and other issues concerning pharmaceutical companies, advance practice nurses should become involved politically to be successful advocates. 10 In this arena, advocacy is important to protect consumers of pharmaceuticals. As patient advocates, NPs will prescribe pharmaceuticals strictly in the interest of the patient and not the pharmaceutical companies. This advocacy should include disputing anything unethical on the part of a pharmaceutical company, as well as helping to implement policies that will allow a positive relationship between health care providers and pharmaceutical companies.


Sarah Sidiqi, RN, BSN




1. Wazana A: Physicians and the pharmaceutical industry. Is a gift ever just a gift? JAMA 2000: 283( 3); 373-380. [Context Link]


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3. Relman AS: Separating continuing medical education from pharmaceutical marketing. JAMA 2001: 285( 15); 2009-2012. [Context Link]


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