How Pharma Companies Influence Medical Decision Making
Pharmaceutical companies that manufacture a particular kind of drug can maintain their monopoly over this product through patent protections, preventing other companies from manufacturing, marketing, and profiting from the drug. However, drug patent protections do expire; most drugs are initially protected for around twenty years in the US, though the particular lifetime of these patents will vary depending on the particular country and drug. Once patents expire, other countries can come into the market and manufacture generic drugs that compete against brand-name medicines. Often, these generic drugs are significantly cheaper than their brand-name counterparts, and so reduce the profits of established pharmaceutical companies.
When only one particular pharmaceutical company manufactures, let’s say a vaccine, for a particular illness, then physicians essentially must prescribe that product. However, when other competitors can create the same or similar products, their prescription is less guaranteed, especially when there are more affordable alternatives for patients.
One strategy to ensure prescription is through more traditional marketing techniques, such as television ads and billboards. Arguably, this form of marketing is directed towards patients, who either buy the drug off the counter or ask their doctor for more information about the medicine.
Another strategy, which is more contentiously implemented, is to give physicians payments and benefits in exchange for higher brand-name prescription rates. For some, the issue is ideological. Some physicians dislike the claim that they can be “bought out” by pharmaceutical companies. So, they strive to distance themselves from corporate influence. For others, the issue is causal. Some physicians claim that there is no connection between the payments they receive and how they prescribe drugs.
The former issue is hard to resolve. Studies have shown that most doctors in the US take money from drug and device companies, with around three quarters of physicians across five medical specialties receiving at least one payment in 2014. The five specialties studied were family medicine, internal medicine, cardiology, psychiatry, and ophthalmology, and the numbers varied between states. At least in the US, the practice of receiving payments is relatively entrenched within the medical profession.
These payments can be relatively simple, and can include meals and samples from company representatives. However, these payments can also be quite substantial, especially for physicians who actively accept pharmaceutical support and seek lucrative connections with brand-name companies. For example, these physicians can be sought for speaking engagements, endorsing particular drugs or devise to fellow practitioners in exchange for a substantial speaking fee. Others include travel expenses, consulting fees, and general gifts. Some physicians receive tens of thousands of dollars a year from these payments.
The latter issue of establishing a connection between pharmaceutical payments and brand-name prescriptions is increasingly being addressed by studies and discussions within the profession. A recent ProPublica study, for example, found that US physicians who received more than
$5,000 from companies in 2014 were more likely to prescribe brand-name drugs. The analysis suggests that these payments are helpful in changing prescription practices and, ultimately, in generating profits for pharmaceutical companies.
The outcomes of these studies simply affirms beliefs by ideological objectors to this common practice. The consequences, they claim, can be quite significant for patients. Generic versions of brand-name drugs are biochemically similar or identical to each other. Thus, the generic versions reinforce the claim that they are as effective at addressing the same patient illness. As such, prescribing more expensive drugs and devices may disproportionately affect those who can only comfortably afford cheaper generic versions. More importantly, it suggests that physicians can be influenced to make medical decisions based on monetary compensation rather than on efficacy. The worry here is that physicians are not entirely making medical decisions for their patient’s best interest, and consequently are eroding patient trust.
There are relatively fewer studies on how this practice affects medical decision making in low- and middle-income countries. If the outcomes are similar, it could have even greater consequences for their patients, some of whom are less empowered to speak out and request the cheaper alternatives.
Addressing the issue of physician payments will likely require changing professional norms to more openly discuss the influence that these connections can have on medical prescriptions. Only time will tell, however, whether the profession will be receptive to these criticisms.