The stereotypical law student’s first day is summed up as follows: students think they are entering the field for the public good, while their neighbors are in it for a hefty paycheck. A study published in the Journal of General Internal Medicine indicates that medical students have a similar experience and found that while students and residents felt confident they could accept gifts from the pharmaceutical industry and remain unbiased, they couldn’t say the same of their peers.

The split should appear somewhat familiar: a late 2012 ethics study showed doctors fell on both sides of the conflict of interest issue, with some saying calming a rumbling stomach would do nothing to influence their prescribing choices, and others saying the more distance between doctors and industry, the better, even if it means brown-bagging it.

The General Internal Medicine report also comes on the heels of a BMJ study which showed that schools with tight gift bans had doctors who appeared to be more pitch-resistant. Yet the General Internal Medicine study accounted for schools with and without bans and found no difference. Researcher Aaron Kesselheim told MM&M this was unexpected and the reason could be because on-school policies were not being enforced at hospitals or practices.

Kesselheim’s team, which focused on 1,610 students found two information sets of note: one was that despite school gift bans, the number of medical students receiving industry gifts was on the rise, with 33% of first-year medical students saying they had been given gifts and 56.8% of fourth-year students saying they’d been similarly treated. Gifts included items like off-site meals and samples. The second study was that the farther along they were in their studies, the less suspicious they were of pharma-provided interactions and the more likely they were to find the interactions informational.

Rather than complement or contradict the BMJ study, both Kesselheim and Pratap Khedkhar of marketing firm ZS Associates told MM&M that the studies are pieces of the same conversation. The lack of commonality makes crafting a gift-influence narrative challenging. Khedkhar said a more holistic perspective would include not just the front-end interactions, but the prescribing behavior as well as the patient response, with the patient component providing a degree of feedback regarding the behavior itself (i.e., why the drug was chosen).

“Drugs are about 10% of medicine,” Khedkhar said, adding that within this spectrum of information and action, the industry can play a role, with the professional’s understanding of it being for informational purposes. “There is education and information which is very legitimate, I do not want my physician to be uninformed,” he said, while at the same time, he wants to know his doctor has not been swayed. “Focus not only on part of the chain” but on the entire process, he said.