Medical staff involvement in such contract research takes time away from teaching, and financial connections with the sponsoring companies sometimes create conflicts of interest that affect the objectivity and even the credibility of clinical teachers. The proliferating connections between teaching hospitals and pharmaceutical firms are threatening the integrity of clinical teaching programs through other kinds of arrangements. Sales representatives of drug firms have always sought to market their employers' products through visits to practicing physicians in their offices. In former times, most teaching hospitals discouraged such visits with the resident staff, believing that their own faculty, and not the pharmaceutical industry, had a responsibility to educate residents and medical students about the uses of prescription drugs in medical practice. Now teaching hospitals seem eager to cooperate with the pharmaceutical industry, because the industry not only supports clinical research but also takes part of the burden of clinical education off the hospitals' budget.
Sales representatives are now welcome at most teaching hospitals.
They attend and support educational conferences, are present in the operating rooms to advise on the use of their companies' new surgical devices, and they lavish free meals, free trips to medical meetings and all kinds of professional gifts on residents, students, and staff in exchange for the opportunity to hawk their wares. Hungry for financial support wherever they can find it, teaching hospitals are turning over increasing parts of their educational responsibilities to the pharmaceutical industry. The long-term effects of this dereliction on the quality and the rigor of the clinical education being received by medical students and residents in the teaching hospitals may be devastating. Physicians are supposed to be trusted and expert advisers to their patients on the effectiveness and the safety of prescription drugs and medical devices. They must be relied upon to judge the relative value of competing products.