• Melissa A Fischer, Mary Ellen Keough, Joann L Baril, Laura Saccoccio, Kathleen M Mazor, Elissa Ladd, Ann Von Worley, and Jerry H Gurwitz.
• University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA. fischerm@ummhc.org
• J Gen Intern Med. 2009 Jul 1; 24 (7): 795-801.

ContextResearch suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs).ObjectiveTo describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions.Design, Setting, And ParticipantsMulti-disciplinary focus groups with 61 participants held in practice settings and at society meetings.ResultsMost prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings.ConclusionsDespite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring the current primary care model and offering convenient, individualized, non-biased educational options may aid success.

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