How the Pharmaceutical Industry approaches and influences Physicians

In recent decades, the pharmaceutical industry has consolidated itself as one of the most powerful sectors of the global economy and, beyond innovation, sustains part of that power through controversial strategies of marketing, lobbying, and influence over research, regulation, clinical guidelines, and medical practice itself. This science report synthesizes the main findings of the study “Relationships and Influences of the Pharmaceutical Industry on Medical Practice”, based on an analysis of Open Payments (CMS), the United States’ public system that records transfers of value to physicians and teaching hospitals. The data indicate that, between 2015 and 2024, manufacturers reported about US$ 23.2 billion in payments to physicians and US$ 23.3 billion to teaching hospitals, highlighting the scale of a mechanism that operates through both large contracts and everyday “courtesies.” The reviewed international literature converges in associating these benefits with changes in prescribing patterns - often subtle and even unconscious - including a greater preference for brand-name drugs, closer alignment with products from paying companies, and increased costs for health systems, sometimes with marginal clinical gains. Edge cases, such as controversies involving Xarelto and the Insys/Subsys promotional scheme amid the opioid crisis, illustrate how incentives and promotion can approach illicit practices, although the more common influence is discreet and routine. The report discusses explanatory mechanisms from social psychology and communication - reciprocity, self-serving bias, and the third-person effect - and highlights the central role of meals and small gifts, with evidence of a dose–response effect, suggesting that repeated interactions may increase receptivity to promotional messages even without physicians’ conscious awareness. Finally, it addresses the “hidden curriculum” in medical schools and argues that transparency and caps on gifts are insufficient, advocating structural responses: stronger restrictions and transparent, institutional funding models with independent governance to protect clinical integrity, reduce conflicts of interest, and preserve public trust.