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Posted on 01-27-2012

Morning! The following was a critique written in the Medical Journal of Australia from some concerned physicians reporting that pharmaceutical "gifts" to physicians are altering prescribing habits.  Combine this with direct to consumer drug advertising and you have a win for pharmaceutical corporate profits and not necessarily what is good for the patient.  

This has ethical implications for doctors, as it affects the trust required in the doctor-patient relationship.

Doctors need to recognize they are affected by drug marketing, and take steps to maintain their independence from the pharmaceutical industry.

THIS AUTHOR ALSO NOTES:

The leaders of the medical profession in Europe and North America are calling for a critical reevaluation of how the medical profession interacts with the pharmaceutical industry.

However, the leaders of the profession in Australia are in denial about the influence of the drug industry on the prescribing patterns of doctors, the clinical research agenda, and bias in the publications of pharmaceutical research findings.

Pharmaceutical promotion does influence the prescribing practices of doctors.

There is overwhelming evidence that doctor-prescribing habits are influenced by the industry.

The medical profession is dependent upon support from drug the industry.

"The medical profession must look at its own conduct and not place responsibility on the pharmaceutical industry."

"The pharmaceutical industry has learnt to influence our prescribing behaviour indirectly, and uses 'opinion leaders' from within the profession to promote its products and to help identify its research agenda."

"There is also clear evidence of publication bias, selective publication and selective reporting of sponsored clinical trials."

"The pharmaceutical industry mostly consists of public companies with legally mandated responsibilities to shareholders and legitimate rights to promote their products."

"My criticism is of the naïveté of doctors and/or their unwillingness to accept overwhelming evidence that the techniques used by the industry to increase prescribing of their products actually work."

Doctors have "direct face-to-face visits from company representatives (referred to as 'drug reps' rather than 'sales reps')."

"Also common are indirect interactions via a wide range of marketing techniques, including direct mailing, advertising in medical journals and medical newspapers, and sponsorship of medical conferences and medical products (such as computer software)."

For some doctors, the interactions are "through involvement in clinical trials or in industry advisory groups, speakers' panels and the like."

"Although only a select few play these latter roles, they are greatly valued by the pharmaceutical industry as 'opinion leaders' in shaping the views of the rest of the profession, especially for new medications."

The drug industry seeks to alter doctor prescribing pattern by doing "'illness Promotion' (using public awareness campaigns in the general media to encourage more people to seek new treatments) and support for patient-help organisations (again indirectly encouraging more patients to present to doctors identifying either their ailment or its desired drug treatment)."

80%-95% of doctors see industry representatives regularly.

"More frequent contact is linked to unnecessary prescribing and to increased use of new drugs."

"Attendance at sponsored conferences is associated with increased prescribing of the sponsor's product."

The industry spends about $21,000 per year per practicing doctor on drug promotion. [WOW!]

"To be a medical 'professional' implies that patients can rely upon the independence and trustworthiness of any advice or treatment proffered."

"It is a significant ethical failing to aspire to such independence and to the respect and trust that underpin an effective doctor-patient relationship while willfully or ignorantly denying the evidence that the pharmaceutical industry does affect our prescribing behaviour." [IMPORTANT]

"The impropriety of this stance is compounded by information asymmetry (where the patient is almost always dependent upon the doctor for information and guidance about medications) and by the fact that the prescribed drugs are usually subsidized by public funds."

The author believes that doctors should choose not to see pharmaceutical company representatives, which would be a very simple step in order to remedy these ethical issues.

Hospitals, colleges and professional associations should make their organizations and their staff or members more independent of the drug industry.

"Medical school faculties and medical colleges must ensure that the ethical issues surrounding relationships with the pharmaceutical industry are included in medical student and postgraduate training programs, and that knowledge and attitudes of students and trainees to the industry are included in formal assessment."

KEY POINTS I WANT YOU TO TAKE AWAY FROM THIS:

1) There are ethical problems in the US, Europe, and in Australia between the drug companies and the doctors that prescribe the drugs, all of which harm the patient.

2)  Drug-marketing techniques affect doctors' prescribing practices.

3)  Drug companies influence the prescribing patterns of doctors, influence clinical research, and there is bias in the publication of drug research findings.

4)  The medical profession is dependent upon support from the drug industry.

5)  The drug industry primarily targets to influence "opinion leaders" in the medical industry with their propaganda.

6) Drug companies engage in publication bias, selective publication and selective reporting of sponsored clinical trials.

7) Drug companies use direct face-to-face visits from drug reps, do direct mailing, advertising in medical journals and medical newspapers, and sponsorship of medical conferences and medical products.

8) Drug companies use medical opinion leaders through involvement in clinical trials or in industry advisory groups, speakers' panels.

9) Drug companies seek to alter doctor prescribing pattern by doing illness promotion in the general media.

10)  80%-95% of doctors see drug industry representatives regularly.

11)  The drug industry spends about $21,000 per year per practicing doctor on drug promotion.

12)  Prescribed drugs are usually subsidized by public funds.

13)  Doctors are largely in denial about all of this.

Keep in natural folks with good nutrition, exercise, and peace/stress management.  Our office offers alternatives for all of them!

Have a blessed day!

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