The pharmaceutical industry is increasingly using its marketing operation to influence nurse-prescribers, and is being aided and abetted in this by the nursing press, it is claimed this week.

A report in the Public Library of Science journal PloS Medicine notes that nurses have increasing power to choose products and services, and to influence choices made by medics and other clinical colleagues. As a result, say the New Zealand authors Annemarie Jutel at Otago Polytechnic and David Menkes at University of Auckland, nurses are now a "desirable target" for the industry.

Drugs companies have been criticised in the medical literature for exploiting patients and doctors using a range of techniques such as direct-to-consumer advertising, sponsored teaching materials, research funding, ghost writing, gifts, free meals, and travel. However, the nursing literature, say the authors, "has yet to pay much attention to the expansive reach of the pharmaceutical industry into the nursing profession".

To study the industry's relationship with the nursing press, the authors searched two leading clinical news databases, MedLine and CINAHL, in May 2007, using the terms such as "pharmaceutical industry," "drug sales," "direct-to-consumer," "gift" and "pharmaceutical," and compared the results with or without restricting the search to nursing journals.

They included all articles making reference to nursing's relationship to drug companies and those that included the perspectives of the pharmaceutical industry on this issue; 32 articles met the inclusion criteria.
Concerns about the role of the pharmaceutical industry were expressed in 13 of the articles. But the rest were ambivalent or positive about industry involvement.

One opinion piece in a nursing economics journal praises direct-to-consumer-advertising (DTCA) as an antidote to medicine's self-interested reluctance to share information. Three articles encourage healthcare professionals to work with the pharmaceutical industry to promote accurate patient information.

An editorial in the Journal of Pediatric Health Care, starts by acknowledging and appreciating the pharmaceutical industry's support of nurse practitioners, and then criticises the industry for failing to court nurse practitioners or make reference to them in DTCA as they do doctors. Some articles, including those written by journal editors, suggest gifts from pharmaceutical representatives valued up to £50 are acceptable.

Benefiting patients
Guy Willis, a spokesman for The International Federation of Pharmaceutical Manufacturers & Associations, conceded that the industry directed its marketing activities at nurses as well as doctors. However, he said the strategy benefited patients. "The industry believes that this marketing effort is essential and overwhelmingly beneficial, ensuring that health professionals are informed of new treatment options."

He added: "The omission of any reference to the industry's self-regulation of its marketing activities directed to health professionals illustrates the narrow, lightweight and unprofessional nature of this article...The article's lack of rigor is further underlined by the authors' failure to advance any evidence whatsoever to support their 'conclusion' that pharmaceutical industry's marketing activities focused on nurses has "been at the expense of the health budget, evidence-based care, and nursing integrity".