The pharmaceutical industry is under mounting scrutiny because of rapidly increasing expenditures for drugs in the United States. Drug expenditures are now the fastest-growing component of health care costs, increasing at the rate of about 15 percent per year.1,2 They account for about 8 percent of health care spending, and at their current rate of increase, they will soon surpass spending for physicians' services and, for many health maintenance organizations (HMOs), the costs of hospitalization.

Many of the policies and procedures for the ethical oversight of research were put in place in an era when public funding was much more prominent than it is now. Over the last 2 decades there havebeen major changes, with increasing pressure on universities, teaching hospitals and individual researchers to seek industry sponsorship for research, and the pharmaceutical industry has become the single largest direct funder of medical research in Canada, the United Kingdom and theUnited States.

OBJECTIVE:
To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour.

DATA SOURCES:
MEDLINE and HEALTH searches for English-language articles published from 1978 to 1993, supplemented by material from the author's personal collection.