Relationships and Influences of the Pharmaceutical Industry on Medical Practice

With annual revenues of around US$ 1.5 trillion, the pharmaceutical industry has, in recent decades, consolidated itself as one of the most powerful sectors in the global economy, exerting significant influence over knowledge production and medical practice. This article critically examines relationships between the pharmaceutical industry and medical education and practice, focusing on transfers of value – such as payments, gifts, and financial incentives – directed to physicians and academic institutions, from undergraduate training to professional practice. The study combines a descriptive documentary analysis of data from the Open Payments program in the United States – where such transfers are regulated and publicly disclosed – with a narrative review of the international literature. Empirically, it is observed that between 2015 and 2024, reporting entities under Open Payments (including drug and medical device manufacturers) transferred approximately US$ 23.2 billion to physicians and US$ 23.3 billion to teaching hospitals in the United States, primarily in the form of meals, travel, educational support, consulting, research, and other remuneration. In light of the international literature, these transfers are examined as part of engagement and influence strategies targeting prescribers: observational studies indicate associations – often operating unconsciously – between receiving benefits and increased prescribing of products from paying companies, a greater share of brand-name drugs at the expense of generics, the promotion of products with marginal clinical benefit, and higher costs for health systems. Drawing on theoretical frameworks and concepts from social psychology, behavioral economics, and communication theory – such as reciprocity, self-serving bias, unconscious influence, and the third-person effect – the article discusses how even low-value benefits, such as meals, can function as mechanisms of socialization and become embedded in the “hidden curriculum” of medical training, normalizing conflicts of interest and shaping professional identities. Finally, the article argues for transforming the logic governing relationships between industry and the medical field through greater transparency, restrictions on gifts, and the strengthening of institutional models of funding and governance aligned with public health.