These days, it seems like every TV commercial break is filled with nothing but ads for medications. Drug firms spend a lot on marketing. In 2013, Johnson & Johnson – the drug company with the highest annual revenues – spent $17.5 billion on sales and marketing. That’s more than double the $8.2 billion they spent on actually researching and developing new medicines.
But Big Pharma spends more on marketing to doctors than consumers. A lot more. And that kind of money can affect a doctor’s decisions on which medicines to prescribe. That is, after all, the reason why drug makers spend so much money marketing to doctors.
This marketing to doctors takes many forms, the most common being a fairly low-tech, tried-and-true approach: free food. Pharmaceutical sales reps make regular rounds to doctors’ offices and bring along sandwiches and cookies for the doctors and nurses.
That seems harmless enough. But again, if free meals weren’t known to influence doctors’ prescribing decisions, there wouldn’t be any free meals.
Cookies and cash
In addition to these edible freebies, drug companies pay much more to doctors in the form of speaking and consulting fees, or even as stock options that were collectively worth a total of half-a-billion dollars in 2015.
It’s not just a handful of doctors getting this money. Nearly half of primary care doctors received some kind of payment from a drug company in 2015, and 61 percent of surgeons got money.
It may not be so concerning when a handful of free chocolate chip cookies nudges a doctor to prescribe one antibiotic over another. But when the perks are convincing doctors to prescribe medications such as opioids when they otherwise wouldn’t, that could cost people their lives.
There is an insidious logic to how this works: the more money a drug company pays a doctor, the more opioids the doctor prescribes, and the more a drug company rewards that doctor for prescribing opioids.
This continuous loop of money-pills-money-pills is one reason we have an opioid epidemic. We need a system that rewards doctors for smarter opioid prescribing instead of more opioid prescribing.
Who and how much?
Transparency is a good starting point. Consumers should be able to find out whether their doctor or hospital is receiving money from drug companies. The Affordable Care Act included a provision that created the Open Payments program to collect information about doctors and teaching hospitals who are getting some kind of benefit – free travel, research funding, gifts, speaking fees, meals – from drug companies and device manufacturers. Consumers can review the Open Payments database to see who’s getting money from whom.
As a practicing physician, I was curious to see whether I was listed on the Open Payments web page. Sure enough, there I am, noted as having accepted several hundred dollars of services from a drug company in 2014. From the timeframe listed, I can tell that my benefit came in the form of sponsored lunches that were served during training and continuing medical education seminars.
This is a much more subtle form of attempted influence than stock options or large cash payments paid to some doctors, but it does show us that drug companies are trying to shower doctors with gifts both big and small.
Consumers need more of the kind of transparency provided by Open Payments. And on the doctor side of the equation, we need ethics rules in medical licensing that curb potential conflicts of interest. Accepting money or free services from a drug vendor can cause a doctor to feel obligated to somehow return the favor, and in this case, that return comes in the form of prescriptions.
Any policies that encourage doctors to prescribe more opioids need to be reviewed. A doctor’s judgment on prescribing medications – especially opioids – should not be influenced by drug companies who seek to “buy” that doctor’s loyalty or try to place a doctor in a position of servitude.
Paying doctors to prescribe opioids needs to stop – before one more life is lost or ruined.
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