YAHANDA: Mind over medicine

The pharmaceutical industry and doctors should minimize their collaboration on drug promotion

The healthcare system should place patients’ well-being above all else. Sadly, when it comes to drug manufacturers, trying to reap additional profits can often supersede patient interests. To that end, British pharmaceutical giant GlaxoSmithKline (GSK) is now attempting to rebrand its image after being accused of bribery in five different countries. GSK is restructuring its sales model by opting to directly employ more doctors while ceasing payments to outside physicians. However, it is still unclear whether GSK truly wants to become an ethical leader in the pharmaceutical industry or is just changing its sales approach in order to save face. Either way, GSK’s restructuring could lead to further calls for necessary ethical reform in the pharmaceutical industry.

The amount of interaction that goes on between physicians and drug companies is unsettling. It is estimated that 94 percent of doctors have received some sort of gift from the pharmaceutical industry. These gifts, often disguised as “educational” or promotional material, are used to influence doctors’ prescribing habits. Gifts, however, are just one way to sway physicians. Companies may attempt to persuade doctors through free meals, payments for presenting certain drugs at conferences or by labeling physicians ‘opinion leaders’ for their work pushing their products. And, frighteningly, these tactics work: research indicates that doctors are often more influenced by pharmaceutical propaganda than they actually believe. That is, even though doctors do not think that pharmaceutical gifts are priming them towards prescribing certain drugs, the evidence suggests otherwise. In one study, physicians were significantly more likely to request drugs for a hospital formulary if they had been contacted or influenced by the manufacturers of those drugs; in another, physicians who were paid by pharmaceutical companies to give speeches ended up prescribing hundreds of thousands of dollars more of the drugs about which they spoke.

On the one hand, this relationship between the pharmaceutical industry and medical professionals could be rationalized as helpful. Doctors are ultimately the ones who decide which medications a patient will take. Shouldn’t they be as informed as possible about what they choose to prescribe? Taken in this light, pharmaceutical companies’ promotional strategies do not seem so harmful. Indeed, they seem like a necessary way by which both doctors and patients can obtain additional information. The more a doctor can tell a patient, the better decisions the patient can make — that is the bedrock of informed consent.

Conversely, doctor-pharmaceutical industry associations can be dangerous. A healthy partnership assumes that pharmaceutical companies are always truthful and forthcoming towards doctors about the uses and side effects of their drugs. This is not always the case, though. One must look no further than the myriad of lawsuits that have been brought against pharmaceutical companies in the past. Certain companies have been known to obscure dangerous side effects, and have encouraged — or provided incentives for — doctors to prescribe drugs for off-label uses that have little proven efficacy. Moreover, drug companies have been convicted of multiple submission or selective reporting of study results, both of which artificially inflate drug benefits or downplay drug hazards.

The contact between physicians and the pharmaceutical industry, then, should be minimized. What is disguised as educational beneficence on the part of drug companies is actually subversive manipulation for the sake of boosting sales. As a result, patient autonomy is compromised rather than enhanced: doctors are either unduly influenced or have been fed false information by pharmaceutical companies, both of which make establishing proper patient consent more difficult. Doctors who allow themselves to be tempted by big pharma are hurting their abilities to effectively care for patients.

To that end, GSK’s new standards should prove constructive. Although the company will be directly employing more doctors, its efforts to woo outside physicians will decrease. There will hopefully be fewer incentives for doctors to push off-label uses of drugs, too, since GSK is halting incentives to deceptively sell certain drugs. Despite the fact that this move may not be sincere (GSK could be trying to rebrand itself to help business and not actually care any more about ethics), severing ties between doctors and the pharmaceutical industry is beneficial. And, if consumers and the media hail this restructuring as a welcome ethical step, other drug companies may soon follow suit and restructure their sales models in a similar manner. With any luck, GSK’s decision is indicative of the future for other pharmaceutical companies.

Alex Yahanda is an Opinion Columnist for The Cavalier Daily. He can be reached at a.yahanda@cavalierdaily.com.

Published April 21, 2014 in Opinion

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