Nine in 10 U.S. physicians accept gifts such as lunch or free samples from drug and device makers, with heart doctors twice as likely as others to get cash payments, a survey found.

In addition, meetings with sales people at doctors’ offices are on the rise, reflecting a possible “intensification” of industry efforts to market products, said researchers who surveyed 1,662 physicians in six specialties. The results were published in the April 26 New England Journal of Medicine.

Medical and industry groups in the last five years have instituted voluntary restrictions on gifts from companies, limiting their value to $100 and focusing on products such as medical dictionaries that may benefit patients. While ties to drugmakers may help companies develop better products and improve doctor education, the benefit to patients isn’t always clear, the researchers said.

“To what extent do patients benefit if doctors receive money for giving talks at conferences?” asked Eric Campbell, the lead researcher and an associate professor of medicine at Massachusetts General Hospital and Harvard Medical School in Boston. “There is no data to address that.”

Overall, 94 percent of doctors said they accepted gifts, money or drug samples from industry representatives.

The most common tie, involving 83 percent of physicians, was the acceptance of food and drinks in doctors’ offices. More than one-third were reimbursed for expenses from attending medical meetings or continuing-education classes, and 28 percent received payments for consulting, speaking about specific medications or serving on an advisory board.

Ties Defended

The pharmaceutical industry defended the ties, saying doctors, patients and companies all benefit.

“Pharmaceutical marketing is one of several important ways for health-care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated,” said Ken Johnson, senior vice president for the Pharmaceutical Research and Manufacturers of America, a trade group based in Washington, in a statement.

The organization issued a voluntary marketing code in 2002 that said accepting tickets for entertainment, including sporting goods and golf, was inappropriate. Gifts shouldn’t exceed $100 in value and should support a medical practice, while meals should be “modest.”

In the survey, 7 percent of doctors said they received tickets to cultural or sporting events.

Relationships Vary

“The goal is to make sure the focus of conversations between company representatives and physicians remains providing accurate information about medicines,” he said.

The relationships varied widely, depending on specialties, types of practice and personal characteristics, the survey found. Solo doctors and those in group practices were more likely to have ties to industry than those in hospitals or health clinics.

The most-influential doctors, such as cardiologists and those who write practice guidelines, were the most likely to receive payments for consulting, speaking about medical products and serving on advisory boards.

“It appears pretty clear that industry forms tighter relationships with doctors who are really the thought leaders, the ones who are likely to affect the behavior of other doctors,” said David Blumenthal, director of the Institute for Health Policy at Massachusetts General.

The study will add to calls for doctors to avoid such conflicts and to find other ways to restrict marketing, said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, in a telephone interview.

`Troubling’

“Most people would say that given the power of doctors to prescribe medicine and control the allocation of resources in health care, this level of marketing is troubling,” he said. “It looks in some ways to be a constant din in the background of the physician’s life.”

The ties between industry and medicine should be encouraged, said Thomas Stossel, a professor of medicine at Harvard Medical School, in a telephone interview today. About 85 percent of medical progress can be attributed to the work of drug and device companies, while 15 percent stems from public funding.

“The corporate involvement in medicine is a natural, evolutionary adaptation to opportunity,” Stossel said. “Products beget more products. They need to be marketed, because doctors need to know they exist. It’s a natural, symbiotic relationship.”

By Michelle Fay Cortez