Sean Philpott: Drug Pushers
Like many academics -- and contrary to the image of college professors as lazy scholars that take sabbaticals every other year and have their summers off -- I about have four or five full-time jobs. I direct a graduate program in bioethics, teach six courses (including two summer courses), and supervise four students each year as they complete their Masters projects.
I also oversee an international training program, write and review federal grants, publish scholarly papers, record commentaries like this, edit a professional journal, and chair several institutional, professional and government committees. My colleagues do the same.
One of these colleagues, a professor at a prestigious university in Australia, just lost one of his five jobs. The Royal Australasian College of Physicians disbanded its ethics committee last week, which he chaired. It was disbanded just days after producing a report that criticized Australian doctors ties to drug companies. Release of the report was also quashed, leading many to speculate that the pharmaceutical industry strong-armed the College of Physicians to prevent a public denunciation of its drug marketing practices.
Drug companies spend over $10 billion a year to influence physicians and patients using a variety of techniques. They hire physicians as spokesmen and advisors, pay clinicians to recruit patients for clinical trials, sponsor professional conferences and training programs at luxury resorts, and send a bevy of attractive salespeople bearing drug samples and gourmet sandwiches to doctors offices.
Over 95% of American physicians have some sort of relationship with drug and medical device companies, ranging from paid consulting gigs to receiving food in the workplace. While taking a slice of pizza or a free coffee mug might not seem like a big deal, it is an incredibly effective marketing tool.
Of dozens of studies looking at physician prescribing habits, every one found that doctors are more likely to prescribe heavily promoted drugs to their patients even when there were cheaper and more effective treatments available. A gift as small as a ballpoint pen was found to affect treatment decisions.
Because of this, many medical schools, hospitals and clinics now prohibit their staff from taking gifts or accepting meals from drug company representatives. Most medical societies have also developed strict guidelines designed to reduce pharmaceutical industry influence on clinical practice. Finally, as part of the Affordable Care Act (or Obamacare), Congress passed the Physician Payment Sunshine Act.
The Sunshie Act requires drug companies and medical device manufacturers to report any payments -- be they consulting fees, gifts, or sponsorship of training programs -- they make to doctors and teaching hospitals. These records will be publicly available starting in 2014, allowing you to check how much money your physician received from Pfizer before you fill that prescription for Lipitor.
This sounds like a great idea in practice, but it probably won't make a damn bit of difference. Money and gifts aren't the only way that the pharmaceutical industry influences treatment decisions.
Consider, for example, free drug samples. These samples are excluded from the reporting requirements of the Sunshine Act, and doctors and patients love them. Free drug samples let doctors and patients see if a particular course of treatment is effective at little to no cost, and can be used to provide care to poor patients that lack prescription coverage.
But pharmaceutical companies don't provide free samples of low cost generic drugs, only the latest and greatest (and most expensive) new treatments. Once these samples run out, a patient is unlikely to request and a doctor unlikely to recommend cheaper alternatives. In the long run, patients end up paying more with the free samples than they would if they'd be prescribed a lower cost but equally effective drug.
This isn't to say that your doctor is in the pocket of the drug companies, even if she consults for Eli Lilly and has a closet full of Pfizer-branded swag. But her prescribing practices may be influenced in subtle ways that she is unaware of.
This also isn't to demonize the pharmaceutical industry. Drug companies produce valuable lifesaving medicines. But these companies are beholden to corporate shareholders. It makes sense that they want to maximize profits while easing patient suffering. The easiest way to do that is to convince you that you need the latest and greatest drug, even if cheaper alternatives exist.
There's nothing inherently wrong with this, even though it contributes to the escalating cost of medical care in the US. It is that very profit that provides the incentive for these companies to develop the dozens of miracle drugs that have come on the market over the last thirty years.
So how can you be sure that the drug your doctor just prescribed is the right one for you, both in terms of cost and effectiveness? The answer is quite simple: stop being so naive. Stop asking for the latest and greatest drug simply because you saw a commercial for it while watching the evening news: newer doesn't always mean better. And stop assuming that the drug your doctor recommends is the best choice: inquire about alternatives, including low-cost generics, and ask why they are or are not right for you.
A public health researcher and ethicist by training, Dr. Sean Philpott is Director of Research Ethics for the Bioethics program at Union Graduate College-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of Union Graduate College's Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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