Pharmaceutical Industry Gifts to Physicians: Patient Beliefs and Trust in Physicians and the Health Care System

BACKGROUND: Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. OBJECTIVE: To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. DESIGN: Cross sectional random digit dial telephone survey. PARTICIPANTS: African-American and White adults in 40 large metropolitan areas. MAIN MEASURES: Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. KEY RESULTS: Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). CONCLUSIONS: Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.