Physicians' prescribing practices do change based on gifts such as meals, conferences, and other perks received from drug companies, according to a just-published study in the Journal of the American Medical Association. Interactions between physicians and the pharmaceutical industry are not as innocuous as they seem. Pharmaceutical companies spend more than $11 billion each year to promote and market drugs -- an estimated $8,000-$13,000 per physician per year. This money is often spent in the form of meals and entertainment as physicians listen to discussions about a particular medication, or as money for books or medical supplies, for example.
Physicians are human; they are not exempt from the usual standards when it comes to receiving gifts. Many other industries have explicit principles saying, 'No one in this company accepts gifts from suppliers or contractors.' Why should doctors be different? Physicians are in a strange position because they write prescriptions for other people to purchase. They are making decisions that affect the expenses of others, not their own. It's what you might call a fiduciary relationship. They need to be extremely careful to make those decisions in a rational, unbiased way.
The JAMA researcher reviewed 29 studies that addressed the interactions between physicians and the pharmaceutical industry. Most of the articles showed that physicians' prescribing practices are, in fact, affected by these relationships with drug companies. For example, they tend to prescribe fewer generic medications and more new, expensive drugs even when the drugs don't have any advantages over cheaper medications. Just because something is the most recent and most costly medication doesn't mean it's the most effective. But we all tend to believe in the myth of progress. Many physicians are at a loss on how to keep up with so much information about new medications, so talking with the pharmaceutical representative is very convenient.
The researcher reports evidence of four types of influence. Following drug company overtures to physicians, physicians prescribed a drug manufactured by the sponsor of a medical education program more frequently, hospitals increased their prescribing of a conference travel sponsor's drug, residents increased "nonrational" prescribing of a drug following a meeting with by a company representative, and attitudes about drug company representatives became more positive. The researcher noted that interactions between MDs and pharmaceutical representatives begin in medical school and continue at a rate of about four meetings per month.
In an accompanying editorial, Dr. Robert M. Tenery, Jr., of the American Medical Association's Council on Ethical and Judicial Affairs, writes that the Council has attempted to police physician interactions with drug companies. The most egregious activities have stopped, such as awarding airline miles for prescriptions written, but recently the need for continuing medical education (CME) has driven a resurgence of drug company-sponsored junkets, he says. CME credit is a requirement for licensing in most states. Tenery notes that drug company money and influence "has permeated virtually all levels of physician CME in the form of complimentary meals and entertainment, consultation fees, and pseudo-CME courses." He concludes that physicians and the drug industry need to develop new industry-wide standards to prevent abuses of the system.
http://my.webmd.com/content/article/1728.541655
The Journal of the American Medical Association 2000;283:373-380, 391-393.
Dr. Mercola's Comments: It is unfortunate that most physicians have no clue that the drug companies are spending (on average) $10,000 to influence their behavior. They, of course, do not receive a check, but the perks are quite significant. They also don't realize that they actually lose that much income and more if they factor the time they lose by sitting with the drug company reps and going to their "free" meals and lectures. They are also clueless on what a fiduciary responsibility is, that they need to carefully analyze the costs involved in recommending expensive drugs. Clearly they are sometimes appropriate and can save someone's life. But most of the time they are unnecessary, cause harm and cause the patient to divert much of their hard earned income to the drug companies which further perpetuates this indirect physician subsidy. One thing these drug companies are not is stupid. There is no way they would spend $10 billion a year to do this unless they received a significant return on their investment. Share this article Next Article Loading Please Wait Community Comments (0) Post Your Subcomment (2000 Characters only.) Characters remaining: * Please enter your comment! Edit Your Comment (2000 Characters only.) Characters remaining: * Please enter your comment! Comment deleted violating the aspect of our terms of use Thanks for sharing your feedback! If your feedback doesn't appear right away, please be patient as it may take a few minutes to publish - or longer if the blogger is moderating comments. Share this article Next Article
It is unfortunate that most physicians have no clue that the drug companies are spending (on average) $10,000 to influence their behavior. They, of course, do not receive a check, but the perks are quite significant.
They also don't realize that they actually lose that much income and more if they factor the time they lose by sitting with the drug company reps and going to their "free" meals and lectures. They are also clueless on what a fiduciary responsibility is, that they need to carefully analyze the costs involved in recommending expensive drugs.
Clearly they are sometimes appropriate and can save someone's life. But most of the time they are unnecessary, cause harm and cause the patient to divert much of their hard earned income to the drug companies which further perpetuates this indirect physician subsidy. One thing these drug companies are not is stupid. There is no way they would spend $10 billion a year to do this unless they received a significant return on their investment.