Over 90 percent of practicing physicians accepted gifts or payments from pharmaceutical companies, according to a Harvard Institute of Health Policy study published yesterday in the New England Journal of Medicine.

The study revealed that most physicians received drug samples or small gifts, such as pens or mugs, over a third were reimbursed for costs at professional or educational meetings, and over a quarter were paid for consulting, lecturing, or enrolling patients in trials.

Although pharmaceutical companies may influence doctor’s prescription decisions, this is not necessarily a bad thing, said lead researcher Eric G. Campbell, an assistant professor of medicine at Harvard Medical School.

“People immediately assume that the effect is bad,” Campbell said. “It can be potentially helpful,” adding that such relationships help educate physicians about new drugs and treatments.

The Pharmaceutical Research and Manufacturers of America (PhRMA), a Washington-based trade group funded by pharmaceutical companies, maintains that its current practices are necessary.

Ken Johnson, a senior vice president of PhRMA wrote in an e-mailed statement that “pharmaceutical marketing is one of several important ways for health care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated.”

But according to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, this relationship could translate into reduced quality of care for patients.

Patients may receive drugs that aren’t the cheapest or aren’t best suited for them, said Caplan, adding that a neutral system provided by the government to educate doctors on drugs would be preferable to the current system.

Campbell acknowledged that these gifts gave certain drug companies an unfair advantage.

“We know that this influences doctor prescribing practices. That’s old news,” he said. “It’s marketing. It’s sales. There is no level playing field.”

One impact of this relationship is the cost to drug companies, which, according to Campbell, spend $20 billion marketing their drugs.

“This stuff adds a tremendous amount of money, driving up the cost of drugs,” he said.

While some guidelines regarding such gifts exist, they are only voluntarily enforced.

The PhRMA issued a set recommendations governing its interactions with health care professionals in 2002, stating that offering tickets for entertainment or sporting goods was inappropriate, that gifts should be directly related to medical practice and patient care, and that free meals should be “modest.”