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"Under the Radar": Nurse Practitioner Prescribers and Pharmaceutical Industry Promotions

Elissa C. Ladd, PhD, RN, FNP-BC; Diane Feeney Mahoney, PhD, APRN, BC, FGSA, FAAN; and Srinivas Emani, PhD

Nurse practitioner prescribers exhibited a high rate of contact with pharmaceutical industry promotional activities.

The recent passage of the Patient Protection and Affordable Care Act (healthcare reform), which includes so-called sunshine provisions, may have a significant effect on the industry- terface of industry promotions and NP prescribing. Starting in 2013, these provisions will require pharmaceutical and medical device manufacturers to report all payments made to physician prescribers for services and gifts such as consulting fees, honoraria, entertainment, food, travel, education, and research.20 However, the provisions apply only to physicians or teaching hospitals. Therefore, industry may redirect promotional activities toward NP and other nonphysician prescribers because of the absence of reporting and other constraints for this population of prescribers.

Our analysis has some limitations. The study had a low response rate, affecting generalizability of our findings. However, online surveys have been noted to have low response rates, especially among healthcare professionals.21 Also, our results demonstrated convergent validity with other comparable NP research performed during the same period relative to response rate, educational level, clinical specialty, practice setting, and respondent sex.22

In conclusion, NPs have heretofore been operating “under the radar” regarding research and policy on the influences of pharmaceutical marketing. Although the scope and extent of their prescribing activities have been less than obvious to consumers and to other healthcare professionals, the pharmaceutical industry has clearly taken notice. According to the pharmaceutical research company Verispan23 (now SDI, Plymouth Meeting, Pennsylvania), a 20% increase in marketing between 2004 and 2006 was directed to NPs and other nonphysician prescribers. This is striking considering the substantial number of NPs and their growing role in the delivery of primary healthcare in the United States. Therefore, it is important that all prescribers, including NPs, have access to unbiased information that is not underwritten by industry. Future research should assess influences of evidence-based academically sponsored continuing education programs on NP prescribers’ beliefs and practices.


We thank Melissa Maloney, MS, RN, and Marion Rideout, MS, RN, for their support with initial literature review and data evaluation. We also thank Dr Anthony Guarino for his input on statistical content.


Author Affiliations: From MGH Institute of Health Professions, School of Nursing (ECL, DFM), Boston, MA; Department of General Medicine (SE), Brigham & Women's Hospital, Boston, MA; and Department of Medicine (SE), Harvard Medical School, Boston, MA.


Funding Source: This study was funded by the Attorney General Consumer and Prescriber Grant Program.


Author Disclosures: The authors (ECL, DFM, SE) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.


Authorship Information: Concept and design (ECL, DFM); acquisition of data (ECL); analysis and interpretation of data (ECL, DFM, SE); drafting of the manuscript (ECL, DFM, SE); critical revision of the manuscript for important intellectual content (ECL, DFM, SE); statistical analysis (DFM, SE); obtaining funding (ECL); administrative, technical, or logistic support (ECL); and supervision (ECL).


Address correspondence to: Elissa C. Ladd, PhD, RN, FNP-BC, MGH Institute of Health Professions School of Nursing, 36 First Ave, Boston, MA 02129. E-mail:

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