Physicians are patient advocates. They must make decisions based on their best judgment of what course of action will most effectively alleviate the ailments they have been charged to treat. They are accountable for the wellbeing of their patients and as such must not only earn, but maintain the trust of the individuals they deliver care to. Because of the immense responsibility doctors shoulder, it is imperative that they make decisions in the best interest of their patients. Unfortunately, many pharmaceutical giants have a record of showing that they prioritize profits over patients and often resort to ethically questionable or even downright immoral strategies to coax physicians into prescribing their drugs. A dangerous problem arises when physicians fall victim to these strategies and begin to make treatment decisions based on perks or payments they receive from drug firms. Though there are many guidelines and measures in place to prevent this problem from happening, there is data to support the notion that the Big Pharma’s underhanded methods work.
Though research-based pharmaceutical firms and their lobby groups such as the Pharmaceutical Research and Manufacturers of America (PhRMA) assert that they spend more money on R&D than promotional activities, an estimate by Gagnon & Lexchin (2008) said otherwise. The pharmaceutical industry and healthcare consulting firm, IMS, is usually considered the authority on pharmaceutical companies’ promotional expenditures. However, after finding inconsistencies in IMS’s data, the researchers analyzed figures from 2004 provided by the market research company, CAM, which considers figures reported by drug firms and by physicians. Their resulting approximation was an astronomical $57.5 billion compared to the $27.7 billion reported by IMS, with about $42.7 billion dedicated to marketing that targets physicians.
So where does this money go? The most common destination appears to be the offices and stomachs of doctors. Campbell et al. (2007) conducted a national survey of 3,167 physicians in 2003-2004. 83% of respondents reported receiving food, 78% – drug samples, and 35% – reimbursement for professional meetings and continuing medical education (CME), or programs designed to teach physician more about a certain topic in the medical field. Finally, 28% reported receiving compensation for consulting, giving talks, or enrolling their patients in drug trials. As far as the efficacy of advertising to doctors goes, the tactics seem to continually work. A comprehensive literature review on the issue (which examined 538 studies) by Wazana (2000) found that doctors changed prescribing habits and requested that hospitals add drugs to their formularies after meeting with pharmaceutical representatives. He states: “Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing.”
Why does this matter? While these Big Pharma tactics may not seem harmful, they can incentivize doctors to unnecessarily prescribe drugs or administer drugs for excessively risky off-label use. Such actions of industry representatives pose the threat of misleading or pressuring doctors into making treatment decisions not entirely based on the wellbeing of the patient. To help better illustrate the effects of pharmaceutical industry promotions on physicians and doctors’ attitudes towards these promotions, Steinman et al. (2001) conducted a survey of 117 residents at a large internal medicine residency program. They found that the residents they surveyed often displayed behaviors inconsistent with their ideologies. For example, all the residents who deemed conference lunches and pens as inappropriate promotions had accepted these gifts. Furthermore, 39% reported that promotions and industry relationships have influenced their prescribing habits.
The purpose of this website is to raise awareness about this issue and guide site visitors to government data reporting the various payments made to physicians. My hope is that visitors will look up their doctors on the Open Payments system and question whether or not they may be making prescribing decisions, in part, based on benefits from certain pharmaceutical companies. My hope is that this website urges patients to discuss any potentially concerning information or conflicts of interest with their healthcare providers for the sake of their own wellbeing.
Works Cited:
Campbell, E. G., Gruen, R. L., Mountford, J., Miller, L. G., Cleary, P. D., & Blumenthal, D. (2007). A national survey of physician–industry relationships.New England Journal of Medicine, 356(17), 1742-1750.
Gagnon M-A, Lexchin J. The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States. PLoS Medicine. 2008;5(1):e1. doi:10.1371/journal.pmed.0050001.
Steinman, M. A., Shlipak, M. G., & McPhee, S. J. (2001). Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. The American journal of medicine, 110(7), 551-557.
Wazana, A. (2000). Physicians and the pharmaceutical industry: is a gift ever just a gift?. Jama, 283(3), 373-380.
Though research-based pharmaceutical firms and their lobby groups such as the Pharmaceutical Research and Manufacturers of America (PhRMA) assert that they spend more money on R&D than promotional activities, an estimate by Gagnon & Lexchin (2008) said otherwise. The pharmaceutical industry and healthcare consulting firm, IMS, is usually considered the authority on pharmaceutical companies’ promotional expenditures. However, after finding inconsistencies in IMS’s data, the researchers analyzed figures from 2004 provided by the market research company, CAM, which considers figures reported by drug firms and by physicians. Their resulting approximation was an astronomical $57.5 billion compared to the $27.7 billion reported by IMS, with about $42.7 billion dedicated to marketing that targets physicians.
So where does this money go? The most common destination appears to be the offices and stomachs of doctors. Campbell et al. (2007) conducted a national survey of 3,167 physicians in 2003-2004. 83% of respondents reported receiving food, 78% – drug samples, and 35% – reimbursement for professional meetings and continuing medical education (CME), or programs designed to teach physician more about a certain topic in the medical field. Finally, 28% reported receiving compensation for consulting, giving talks, or enrolling their patients in drug trials. As far as the efficacy of advertising to doctors goes, the tactics seem to continually work. A comprehensive literature review on the issue (which examined 538 studies) by Wazana (2000) found that doctors changed prescribing habits and requested that hospitals add drugs to their formularies after meeting with pharmaceutical representatives. He states: “Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing.”
Why does this matter? While these Big Pharma tactics may not seem harmful, they can incentivize doctors to unnecessarily prescribe drugs or administer drugs for excessively risky off-label use. Such actions of industry representatives pose the threat of misleading or pressuring doctors into making treatment decisions not entirely based on the wellbeing of the patient. To help better illustrate the effects of pharmaceutical industry promotions on physicians and doctors’ attitudes towards these promotions, Steinman et al. (2001) conducted a survey of 117 residents at a large internal medicine residency program. They found that the residents they surveyed often displayed behaviors inconsistent with their ideologies. For example, all the residents who deemed conference lunches and pens as inappropriate promotions had accepted these gifts. Furthermore, 39% reported that promotions and industry relationships have influenced their prescribing habits.
The purpose of this website is to raise awareness about this issue and guide site visitors to government data reporting the various payments made to physicians. My hope is that visitors will look up their doctors on the Open Payments system and question whether or not they may be making prescribing decisions, in part, based on benefits from certain pharmaceutical companies. My hope is that this website urges patients to discuss any potentially concerning information or conflicts of interest with their healthcare providers for the sake of their own wellbeing.
Works Cited:
Campbell, E. G., Gruen, R. L., Mountford, J., Miller, L. G., Cleary, P. D., & Blumenthal, D. (2007). A national survey of physician–industry relationships.New England Journal of Medicine, 356(17), 1742-1750.
Gagnon M-A, Lexchin J. The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States. PLoS Medicine. 2008;5(1):e1. doi:10.1371/journal.pmed.0050001.
Steinman, M. A., Shlipak, M. G., & McPhee, S. J. (2001). Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions. The American journal of medicine, 110(7), 551-557.
Wazana, A. (2000). Physicians and the pharmaceutical industry: is a gift ever just a gift?. Jama, 283(3), 373-380.
