A report by HealthDay News, and carried by the likes of Forbes, reports that 94% of all physicians accept gifts from pharmaceutical companies in exchange for consideration of prescribing their drugs. The HealthDay News report was based on findings published in the New England Journal of Medicine.
Gifts can be as simple as food and beverages or free samples of the drugs, or as complex as underwriting the doctors’ trips to conferences, or reimbursing them when they enroll patients in a clinical trial. Questions about the ethical ramifications are raised, although you might be surprised at some of what I think about it. I can see all sides, I believe.
And as I write this, I should perhaps recuse part of my opinion, because my daughter is, in fact, a pharmaceutical rep. She’s one of those who buys all those free meals for her client-doctors. She’s a corporate credit card carrying member of the sales force of one of the largest pharmaceutical manufacturing companies in the world.
However, there are some questions we patients need to be asking, and some food for thought about the real cost of this practice. It borders on the question of doctors who profit from the drugs they prescribe, and whether that profit comes at the expense of the best interest of the patient. See what you think.
From the point of view of the pharma companies:
“Hey! This is marketing and sales! We’ve developed a drug that has been tested and retested, been approved by the FDA, and now we need to get the doctor’s attention so s/he will prescribe it for patients. What good is a drug if no one knows about it? And how can we get the doctor’s attention if we don’t do something attention-grabbing? It only makes sense to give them free samples of the drugs to hand out to appropriate patients. As for the other gifts? Why not? We write them off as business expensed gifts anyway — so in effect — it costs us far less than one might think. Besides — we’ve got investors who want their stock to go up. So — the giveaways are win-win for us AND the doctors.”
From the point of view of a doctor:
“Hey! My staff loves those free lunches! And — OK — I’ll spend a few minutes with the drug rep so my staff can have chinese this week. Besides, it’s easier for me to listen to the rep and be able to ask him questions than it is to have to sort through the material myself. And, my patients do love it when I can give them samples because it saves on their expense of buying the drug from the pharmacy. If the drug doesn’t work, I don’t have to feel bad that they spent their money on it — I’ll just prescribe something else and give them even more samples. And you know — that conference in Cancun last winter was just great. My wife really enjoyed it, too.”
From the point of view of a patient with insurance:
“Hey! Thank heavens my doctor could give me a drug to stop this awful heartburn! I appreciate the samples — I can start taking the drug while I wait for it to be ready at the pharmacy. Yeah, I know I have to take it for the rest of my life, but insurance covers it, so I don’t really have to pay for it anyway.”
(Excuse the interruption here — but please note that this is a typical insured patient who doesn’t realize that his insurance premiums go up because he thinks his healthcare is “free.” See previous blog posting….)
(Excuse the interruption, part II: do we know for sure that this is the best drug for this patient? Do we think there was any influence on the doctor just because the pharma company paid for his trip to Cancun? )
From the point of view of a patient without insurance:
“Hey! I guess I’m glad there’s a drug to stop my heartburn — but I can’t afford it! The doctor wants me to take this brand — the purple one — but it’s just too expensive! It’s going to cost me $50 a month. If I could afford that, I’d get insurance!”
Bottom line? The ethical questions are many, but no one (I know of) has done any studies to see whether the gifts actually DO influence doctors. And a point to always keep in mind — we can’t just lump all doctors into one sweeping conclusion either. They are human beings and they make choices as individuals.
Does the cost of all those free lunches really have a large impact on the prices we must pay (or insurance or medicare must pay) to purchase the drugs? Does the cost of all those trips to conferences really translate as a question about whether we are getting the best drug for our particular medical needs?
As sharp patients, how do we get our arms around these questions? Is this something we want to tackle directly with our doctors? Somehow, among all the questions I’m NOT afraid to ask, I just don’t picture myself asking, “Thanks for this prescription Doctor. Did its manufacturer send you to Cancun last year?”
And this doesn’t even begin to touch pharma company influences on the FDA….
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