DESIGN: Cross-sectional study.

SETTING: An academic internal medicine residency program, a private internist’s office, and a health maintenance organization (HMO).

PATIENTS/PARTICIPANTS: A consecutive sample of 486 items, excluding gifts and drug samples, distributed by drug companies between August 11, 1993 and March 1, 1994.

MEASUREMENTS AND MAIN RESULTS: Of the 486 items collected, 207 were reprints, 196 were advertisements, 51 were general information, and 32 were other. Reprints were delivered to residents significantly more often than to the HMO (p<.001) or to the private internist’s office (p<.001). By contrast, the internist’s office received a greater proportion of personal correspondence compared with the other locations (p<.001 for both). Of the drugs publicized, 10% were substantial improvements over other therapeutic choices. Forty-two percent of the items failed to comply with at least one of three FDA regulations assessed, including 17 items that discussed unapproved uses for drugs. Advertisements, as well as items that were not obviously promotional, contained promotional characteristics. Thirty-nine percent of the items offered scientific support for their claims.

CONCLUSIONS: Little of the material distributed by pharmaceutical companies to physicians conveys information about important therapeutic breakthroughs; some of it fails to comply with FDA regulations. The material contains both educational and promotional characteristics.