The pharmaceutical industry provides many valuable resources to the field of ophthalmology including education, funding of clinical and basic science research as well as new treatments to assist our pa­­tients. Despite these numerous be­ne­fits a tension often exists in the relationship between the industry and the ophthalmic community. This is, at least in part, because of the differing services the industry and the ophthalmologist provide. The industry promotes products to the eye doctor while he or she cares for the pa­tient's eyes.

Physicians Rate Pharma Companies' Performance

                     General Quality of            Clinical Research        Quality of                  Overall Relationship 
                     Education Provided            Sponsored by Co.        Promotion Pieces   With Co. Rep
                     (ANOVA = <0.001)            (ANOVA = 0.003)        (ANOVA =  0.003)   (ANOVA = <0.001)
Alcon            3.1 ±0.8 (48)                            3.0 ±0.9 (44)                   2.7 ±1.0 (47)                 3.5 ±0.7 (52)
Allergan      3.0 ±1.0 (46)                            2.9 ±1.0 (38)                   2.6 ±1.0 (44)                 3.3 ±0.9 (50)
& Lomb        2.2 ±1.0 (43)                            2.3 ±1.0 (38)                   2.1 ±1.0 (40)                  2.1 ±1.3 (43)
Merck         2.1 ±1.1 (41)                            2.4 ±1.0 (34)                   2.1 ±1.0 (40)                  2.5 ±1.2 (40)
Novartis      2.1 ±1.2 (33)                             2.2 ±1.2 (29)                    2.0 ±1.1 (35)                 2.1 ±1.3 (34)
Pfizer          2.5 ±1.1 (43)                            2.7 ±1.0 (38)                    2.3 ±1.1 (43)                  2.9 ±1.2 (43)
The scores represent the mean ranking, followed in parentheses by the number responding, based on a rating of 0 for Poor to 4 for Excellent.

Therefore, the ophthalmologist must evaluate the suitability to his practice of information derived from educational programs, promotional pieces and clinical research provided by the pharmaceutical industry. Con­se­quent­ly, over time the phy­sician may form an opinion about individual corporations or the pharmaceutical industry in general. Accordingly, pharmaceutical companies frequently survey ophthalmologists by various means (i.e. focus groups, telephone surveys) regarding their views of the products and re­sources that the companies make available. However, this information is rarely released to the public.

It is therefore difficult for physicians to obtain in­for­mation regarding their colleagues' opinions about ophthalmic pharmaceutical companies. Such information might be a useful guide to the ophthalmologist in assessing information re­ceived from an individual company, as well as to direct discussions among oph­thalmic societies regarding how best to assist a pharmaceutical company in its relations with our specialty.


Materials and Methods

We conducted independently an eight-item survey among ophthalmologists in the United States to determine their opinions about the pharmaceutical industry in terms of information services, local field representatives, global relationship and prescribing habits. Although we left space for each physician to comment on any pharmaceutical company, we limited the specific choices to several corporations with an extensive dedicated ophthalmic program, including: Alcon, Allergan, Bausch & Lomb, Merck, Novartis and Pfizer.

We randomly sent the survey by fax or e-mail to physicians listed in the American Academy of Ophthalmology di­rectory. If the physician did not re­spond within two weeks we sent the survey again. Most questions offered a response between 0 and 4 or "no opinion." We averaged the scores by the value of the response (0 to 4). We ex­cluded "no opinion" answers in the average. Statistical analyses were performed with an ANOVA test. In total, 596 surveys were sent twice and we received 52 (8.7 percent) responses.



 • Information Services. When phy­sicians were asked about the quality of education the companies provide, a statistical difference was found with Alcon ranking the highest (3.1, p=0.001). Doctors scored education quality as 2.0 or higher for all of the companies. Most respondents said the Pharmaceutical Research and Man­u­fac­t­urers of America (PhRMA) independent educational guidelines (25/33, 75 percent) were of value to them. However, a number of physicians had no opinion regarding these directives.

Very similar ratings were received from physicians regarding the quality of clinical research. Again, Alcon ranked the highest with an average score of 3.0, but all companies scored  approximately 2.0 or higher (p=0.003). Similarly, Alcon placed highest regarding the quality of promotional pieces with an average of 2.7 (p=0.003). In general, however, the scores of the promotional pieces were slightly lower than those of clinical research or education.

 • Local Field Representative. Physicians ranked the quality of their relationship with the local field representative, again, as highest with Alcon with an average of 3.5 (p<0.001). In general, opinions were positive, with all companies being assessed as 2.0 or higher. Physicians reporting overwhelmingly ranked free product samples for patients as the most important services from the local field representative (47/52, 90 percent). However, physicians also valued: invitations to educational events (26/52, 50 percent), the provision of medical information (22/52, 42 percent) and an avenue to have their questions ans­wered (20/52, 38 percent).

What are the most important benefits (up to three) that the local field representitves offer?

Benefits                                                                         N           %

They provide useful medical information               22           42

They are a resource for obtaining
answers to questions                                                  20            38

They provide invitations to educational events      26            50

They provide invitations to social events                 6             12

They provide free samples of
medicines for patients                                                47            90

The quality of the personal relationship                  3              6

They are superfluous. I base my decisions
on independen
t science, not promotional talk         1             2   

 • Global Relationship.
Overall, physicians indicated Alcon (average of 3.2) as the company to which they felt closest, and with which they identified most with their product, personnel and corporate philosophy (p<0.001). All companies received positive scores of 1.6 or higher. Nonetheless, a mi­nority of physicians had a less favorable perception of Novartis and Bausch & Lomb.

 • Prescribing Habits. When asked what most influenced their prescribing habits, overwhelmingly the physicians indicated the quality of the pharmaceutical product and clinical research results. A distant third choice was the availability of medicine samples. Physicians appeared to value the association with company headquarters and the number of invitations to social events the least.



Although this survey was limited in scope in order to make it time-efficient for respondents to answer the questions, several interesting trends were noted. Alcon generally scored the highest among those physicians who
had an opinion about individual pharmaceutical companies, while Allergan ranked consistently second. The survey did not specifically explore why these two companies demonstrated better scores. However, Alcon and Allergan are smaller in size, and their business mission is more specific to ophthalmology. Con­se­quent­ly, it could be that these characteristics allow for easier development and maintenance of physician relationships. While Bausch & Lomb also is a smaller company dedicated to ophthalmology, both Alcon and Allergan have a wider product line that may assist these organizations in forming relationships with a greater number of doctors.

In contrast, the larger pharmaceutical companies included in this survey with a systemic business (i.e. Pfizer, Merck, Novartis), also had positive results in this survey, but less so than Alcon and Allergan. Novartis had a high no-opinion rate. This may have resulted from the company's focus on promotion being limited to retinal phy­sicians in the past several years.

In general, physicians indicated they felt positive regarding their relationship with the pharmaceutical industry, on a local and national level, based on the medical education, research, products and information the industry provides. Further, physicians noted that their practice benefited directly by the provision of medicine samples. Although the reason for this finding was not queried specifically, samples may allow the doctor to save their patients money and provide an excellent promotional tool for their practice. In addition, this survey indicated that physicians are prescribing based on medical information provided from results of clinical re­search and not from social benefits obtained from the pharmaceutical industry. This was a very positive finding.

The relationship between the medical community and the pharmaceutical industry will likely never be completely free of tension because of the difference in their respective services. This survey indicates, however, that a positive and productive association currently exists between these two professions. Hopefully in the future the pharmaceutical industry and the medical community will continue to work together to improve patient lives and to represent a positive face to the public in general.