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Why Big Pharma’s Persuasiveness Damages Domestic Healthcare

By Sebastian Mendez '19, Staff Writer

· Sebastian Mendez

Imagine, one evening, you’re looking out the window of your NYC apartment. You see a man walk out of his workplace to meet a woman standing nearby. You observe that, after brief discussion, they walk away together. If I were to ask you to guess what was happening, I’d reckon you would report one of two things: either he has met up with a friend for dinner, or he’s doing something suspect. But what you might not have guessed is that the gentleman in question – a medical doctor – is on his way to a paid dinner with a pharmaceutical industry representative.

The financial power of the pharmaceutical industry has allowed drug marketing campaigns – in the absence of sufficient oversight -- to extend to exceptional lengths. Physicians are showered with gifts, free drug samples, and funding for research and education. In the same fashion a wealthy man may court his desired woman with expensive gifts, companies are attempting to convince physicians to prescribe their drugs through extravagant means.  

Pharmaceutical advertising in the United States is so invasive that we are the only country other than New Zealand which allows direct-to-consumer advertisements, as protected by the first amendment. However, this aggressive advertising has hurt physicians and patients alike; so much so that the American Medical Association has proposed a ban on pharmaceutical advertising practices.

The steep costs of drug research -- combined with the lack of government or public funding – means pharmaceutical companies generate their revenue from product sales. Fewer drugs sold, in their view, amounts to less drug research and lack of innovation; more seriously for them, less profit. In 2013, Johnson & Johnson –the biggest pharmaceutical company in the world – devoted almost 50% of its expenditure towards marketing alone, totaling more than $8 billion dollars.

The interaction between a physician and an industry representative culminates in an interdependent exchange: the industry representative cozies up to the physician to convince him to prescribe their drug. Are doctors equipped to handle the predatory advances of pharmaceutical representatives? Studies show us that they aren’t immune to reciprocity.

Multiple domestic and international studies have shown correlations between physician interactions with pharmaceutical companies and their subsequent prescribing patterns. One study highlighted a hypocrisy among a sample of medical students: while 85% believed it was improper for a politician to accept these kinds of gifts, only 46% of them found it improper for themselves to do the same. Furthermore, studies have identified inconsistencies between doctors’ perceptions of source credibility and frequently used sources regarding drug information: despite supposedly distrusting pharmaceutical sales representatives, the physicians referred to them the most for drug information. 

How are patients affected in this regard? Biased physicians may choose to prescribe brand-name drugs at a higher cost to the patient relative to generic drugs that may be equally effective. This is a key point in the AMA’s argument for limiting pharmaceutical marketing efforts. Furthermore, public knowledge of pharmaceutical-physician interactions breeds distrust between the patient and the physician. Even the best doctors are not immune to the human condition; for this reason, there are calls for increased regulation of pharmaceutical marketing practices and the development of educational programs to make physicians more aware of biases that result from interactions with these companies. These changes would encourage cost-conscious medical care and benefit the patient-physician relationship.

If medical doctors, despite their years of education, struggle as a whole to resist the influence of the pharmaceutical industry to their detriment, you may begin to imagine how direct-to-consumer advertising can be problematic since less than a third of the United States population has a bachelor’s degree over the age of 25. Many studies have shown that these advertisements misinform patients, promote drugs with lack of oversight, pathologize normal conditions, encourage drug overuse, and interfere with patient-physician relationships. 

The first of these is evident in the many advertisements you’ve likely encountered. Analyses of national pharmaceutical commercials have shown a disproportionate amount of time given to the listing of benefits as compared to major risks. Furthermore, visual imagery is often superimposed with the limited audio that does list negative side effects; this is a clever psychological “trick” since individuals are more likely to remember the positive connotation of the visual imagery as opposed to the risks. Lastly, the language used in some of these advertisements strays greatly from the recommended comprehension level of the general public, which is around an eighth-grade reading level. All of these factors serve to misinform the patient. 

Contrary to common sense, advertisements do not require any sort of vetting before being aired to the public. The flaw here is that a company can promote their drug on television to patients in the absence of a complete safety profile! The consequence -- which has been observed with multiple drugs in the past -- is that late-emerging side effects cause the drug to be withdrawn from the market. Furthermore, the lack of oversight also contributes to the disproportionate and inaccurate reporting of major drug risks. 

The economic goals of the pharmaceutical company often translate to incorrect public health perceptions. In the past, medications to treat symptoms of menopause have pathologized what is actually a normal stage in a women’s development. It goes without saying that exploiting normal health as a disease and encouraging consumers to seek prescriptions from their doctors is unethical.  Furthermore, saturating the public with commercials for drugs miseducates the public about how to be healthy, as there are alternatives to medicating for certain conditions.

If an individual is motivated to obtain medicine for their condition, studies have shown that the likelihood of a patient switching their physician goes up if they refuse to give the patient the medication of choice. Likewise, physicians have reported higher levels of irritability when patients request specific, brand-name drugs. Many also indicated that they felt patient interaction to be compromised because persuading the patient to avoid a certain drug consumed the limited appointment time they had together. 

It is important to recognize that the current political climate shows no signs of curtailing the pharmaceutical industry’s abuses of power. In fact, the pendulum is swinging in favor of the pharmaceutical industry, with the FDA considering whether to allow marketing of off-label uses – using medication for reasons other than intended -- despite this being a contrast to the principles of evidence-based treatment. Perhaps the snake oil salesmen have not departed after all.

References:

American Medical Association. (2015). AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices. AMA Press Release, 1–2. Retrieved from http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-ban-consumer-prescription-drug-advertising.page 

Brax, H., Fadlallah, R., Al-Khaled, L., Kahale, L. A., Nas, H., El-Jardali, F., & Akl, E. A. (2017). Association between physicians’ interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis. PloS One, 12(4), e0175493. https://doi.org/10.1371/journal.pone.0175493 

Cropanzano, R., & Mitchell, M. S. (2005). Social exchange theory: An Interdisciplinary review. Journal of Management, 31(6), 874–900. https://doi.org/10.1177/0149206305279602 

Eguale, T., Buckeridge, D. L., Verma, A., Winslade, N. E., Benedetti, A., Hanley, J. A., & Tamblyn, R. (2016). Association of off-label drug use and adverse drug events in an adult population. JAMA Internal Medicine, 176(1), 55–63. https://doi.org/10.1001/jamainternmed.2015.6058 

Jacob, N. T. (2018). Drug promotion practices: A review. British Journal of Clinical Pharmacology, 84(8), 1659–1667. https://doi.org/10.1111/bcp.13513

Kronemyer, B. (2018, October 12). The state of off-label drug laws. Retrieved from http://dermatologytimes.com/fda/state-label-drug-laws 

Latten, T., Westra, D., Angeli, F., Paulus, A., Struss, M., & Ruwaard, D. (2018). Pharmaceutical companies and healthcare providers: Going beyond the gift – An explorative review. PLoS ONE, 13(2), 1–16. https://doi.org/10.1371/journal.pone.0191856 

Parekh, N., & Shrank, W. H. (2018). Dangers and Opportunities of Direct-to-Consumer Advertising. Journal of General Internal Medicine, (January 2015), 1–2. https://doi.org/10.1007/s11606-018-4342-9 

Schaper, M., & Schicktanz, S. (2018). Medicine, market and communication: Ethical considerations in regard to persuasive communication in direct-to-consumer genetic testing services. BMC Medical Ethics, 19(1), 1–11. https://doi.org/10.1186/s12910-018-0292-3 

Ventola, C. L. (2011). Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic? P & T : A Peer-Reviewed Journal for Formulary Management, 36(10), 669–684. https://doi.org/22346300 

Yeh, J. S., Franklin, J. M., Avorn, J., Landon, J., & Kesselheim, A. S. (2016). Association of industry payments to physicians with the prescribing of brand-name statins in Massachusetts. JAMA Internal Medicine, 176(6), 763–768. https://doi.org/10.1001/jamainternmed.2016.1709 

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