Nursing education fails to prepare graduates to deal with pharma’s promotional tactics, and many nurses appear to accept promotional materials uncritically, according to an analysis of the nursing literature in PLoS Medicine.

“The pharmaceutical industry recognizes nursing influence on medical prescribing and identifies nurses as a marketing target,” write Annemarie Jutel and David Menkes. “The industry has had its eye on nurses and nurse practitioners for over a decade, and is heavily invested in wooing them.”

They examined nursing literature for papers that explored pharma’s influence on nurses and nursing education. Of 32 articles found, just 13 expressed or reported any serious concerns about pharma’s role in influencing behavior. Four articles were “clearly industry-friendly,” while the remaining 14 expressed mild concern about pharma, viewed industry support as generally favorable, or identified both harms and benefits of pharma involvement.

Nurses should be encouraged to re-evaluate the educational benefits of promotional information, “which is carefully selected, prone to bias, and hardly likely to be as beneficial as many believe,” they write.

“Rather simplistically,” they write, many articles suggest nurses should be “cognizant” or “aware” of industry influence and that by knowing the scope of the problem and working “with” industry, nurses will be able to avoid complicity in unethical promotion. “This optimistic approach belies the fact that many nurses are not trained in critical appraisal, and appear to understand little of the mechanisms by which marketing strategies operate,” they write.

As an example, they cite an article by a ‘medical writer’ with ‘12 years’ experience in pharmaceutical sales training’ in Advance for Nurse Practitioners, who refers to promotional objects as a normal part of professional practice without offering any critical consideration.

The authors call for a three-pronged strategy to combat promotion to nurses: train nurses to understand and manage the impact of commercial activity; institute guidelines and policies to complement nursing education; and conduct research into the role nurses may play in prescribing.

Financial disclosures: Annemarie Jutel previously held shares in Pfizer, but sold them during the preparation of this work. David Menkes has accepted speaker fees and support to attend conferences from various drugmakers. In addition, he has received research support from Roche, Lilly, and Lundbeck, and has served as an expert witness on behalf of plaintiffs in civil cases defended by Lilly, Glaxo and Pfizer.

Hat tip to Science Daily and KevinMD