Running head: ETHICAL CONSIDERATIONS BETWEEN DOCTORS AND PHARMACEUTICAL AGENTS
Amanda Fox
MPH 560
Dr. Toland
June 20, 2014
Fox 1
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 2
Prescription medications have many purposes; mainly to cure and alleviate diseases, as
well as reduce pain. There is a great history of medication use dating back to Egyptian
Civilizations around 3000 BC. "Egyptian doctors used a huge range of drugs obtained from
herbs and minerals. They were drunk with wine or beer or sometimes mixed with dough to form
a 'pill'. Egyptian doctors also used ointments for wounds and they treated chest complaints by
getting the patient to inhale steam" (Lambert, 2014). Much progress has been made in the
making and distribution of medicine since ancient times. The biggest jump of progress occurred
in the 19th and 20th centuries. Some of these advancements included the first non-direct blood
transfusion, first use of insulin, creation and use of the EEG machine, and the discovery of
antibiotics and many other drugs (Lambert, 2014). Prescription drugs play a major role in
society today. In order for an individual to receive a prescription medication, it must be
prescribed by a medical professional including doctors, psychiatrists, dentists, and nurses. With
that being said, there is a relationship between these health professionals and pharmaceutical
agents. This correlation involves billions of dollars of prescription medications being prescribed
annually. Many prescription drugs are prescribed daily, the question is are all these drugs
necessary? Ethically, are doctors and pharmaceutical companies in the wrong for prescribing
prescription medication without informing their patients of a natural way of taking care of their
health issue?
Every year, the amount of prescription medications that are prescribed to individuals
continue to increase. America is known as the nation of pill poppers due to the amount of
prescription medications that are taken daily. In 2010, nearly thirteen prescriptions were
prescribed per man, woman, and child (Global Research, 2014). "We’re one of only two
countries in the world which allows direct-to-consumer Rx advertising; and Rx have slowly
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 3
grown to be the third highest medical cost" (Global Research, 2014, pg. 1). In 1980, prescription
medication usage was a $12 billion industry. In 2010, this industry has grown to costing around
$275.6 billion. This is a significant jump in the past few decades, just showing the amount of
growth this particular field has had. In 2010, there were around 4.02 billion prescriptions filled,
which cost the average American around $898 in prescription spending (Global Research, 2014).
America's prescription costs drastically outweigh prescription costs around the world. In
developing countries, the average citizen will pay around $609 per year by 2016, and in
emerging countries, the average citizen will pay around $99 per year by 2016 (Global Research,
2014). Currently, in the United States, prescriptions are the fastest growing sector in healthcare
costs. The only two healthcare costs that are ahead, for just a short period of time longer, are
hospital care and clinical services (Global Research, 2014). The highest money making
medications include Antidepressants, Attention Deficit Hyper Disorder drugs, and sleeping
medications.
Almost every age group takes prescription medication. Prescription medication use tends
to increase with age, although a large amount of children are taking medications. "In 2007-2008,
1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription
drug in the past month" (CDC, 2010, pg. 1). As stated above, there is a variance in prescription
medication use due to age. In 2008, less than 10% of children under the age of twelve used two
or more prescription drugs, and 1% used five or more (CDC, 2010). Of older American's aged
60 and above, 76% of them used two or more prescription drugs and 37% used five or more
(CDC, 2010). As far as ethnic backgrounds, "the non-Hispanic white population had the highest
prescription drug use and the Mexican-American population had the lowest" (CDC, 2010, pg. 1).
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 4
Who is prescribing all these prescription medications being consumed in the United
States? Health care professionals such as doctors, dentists, psychiatrists, nurses, etc. prescribe
medications out to patients for many reasons. These health care professionals work alongside
pharmaceutical companies and pharmacists to get and prescribe the right medications to their
patients. "When it comes to medication safety, the doctor, the pharmacist and the individual
need to work together as a team. It’s the doctor’s responsibility to prescribe the most appropriate
medication for and individual, and it’s the pharmacist’s responsibility to accurately fill the
prescription as it is written" (Richards, 2014). Although these health care professionals are
meant to help the overall health of each patient, new questions have risen on the true relationship
between pharmaceutical companies and health care professionals.
The health care industry consists of many different professionals. One particular group
of people whom play a vital role are pharmaceutical sales representatives. The overall job of a
pharmaceutical sales representative includes educating health care professionals on their
employers products, offering insights into new types of therapy, helping these professionals to
provide quality care to their patients, and helping patients maintain good health (Abbot, 2013).
The problem that arises with pharmaceutical sales representatives is whether or not they are more
interested in making a sale, or actually educating health care professionals on specific products.
With that being said, for the past few years, these sales representatives were more-so known as
salespeople, interested mainly in meeting sales goals.
In order to reach their target sales goals, these representatives would get doctors and
other health care professionals to buy into intricate gifts they offered. "From giving doctors
elaborate gifts and experiences to recommending off-label uses for drugs, the pharmaceutical
industry had a reputation for playing fast and loose with ethics in the name of the sale" (Abbot,
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 5
2013, pg. 1). Pharmaceutical company's would hand out pens, notepads, stress balls, mouse
pads, etc. that could be found in most doctors and health care professionals offices. "On any
given day, these representatives may be spotted carrying in bags of takeout food for the office
staff, all in an effort to gain a few moments of a busy doctor’s time to pitch the latest and greatest
drugs offered by their company " (Abbot, 2013, pg. 1). As stated above, the purpose of
pharmaceutical reps included educational events to inform doctors of their products. These
educational events would involve a short pitch on the prescription drugs, and would then be
followed by a fancy meal, sports outing, or show experience. The doctors and health officials
would get the "best of the best" during these outings, such as front row seats at a sporting event.
These components were all done in order to persuade doctors to listen, and of course choose that
particular product over others.
The issue arises because health care and prescription medications are not something to be
compromised with. Pharmaceutical sales reps are to fully present the benefits, risks, and side
effects of the medications, in order to help health care professionals make the best choice when it
comes to choosing a medication (Abbot, 2013). When it comes to the elaborate gifts, doctors
were more-so being bribed than informed on the product:
The competition inherent in the pharmaceutical industry — companies spend millions
developing, researching and marketing their products — puts undue pressure on sales and
marketing teams to make sales. And due to doctors’ busy schedules (few are willing to
sacrifice patient care time to meet with salespeople) and the fact the drug company’s
bottom line is riding on sales, some representatives resorted to these less-than-ethical
means to sell (Abbot, 2013, pg. 1).
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 6
As aforementioned, doctors were being bribed on products. They were not taking the time to
fully understand the product they were purchasing, but looking at the best perks that would walk
into their office. From an ethical standpoint, this is wrong for patients going into these doctors
offices and being prescribed these drugs that the doctors were just bribed to purchase.
Another ethical consideration to take a look at with doctors and patients, in particular, are
the amounts of medications being prescribed. Because doctors offices and pharmaceutical
companies have a relationship with each other, a viscous cycle takes place as far as doctors
continuously prescribing medication, which in turn allows them to receive many gifts, and
finally leads to paying the pharmaceutical companies. "The aggressive marketing strategies by
the companies just act as tools of information for them. But the prescribing behavior of a vast
majority of the medical community is palpably influenced by pharmaceutical companies"
(Bansal & Das, 2005, pg. 40). When a physician sees a pharmaceutical rep, they ultimately
believe that these interactions will involve some type of educational value, while also having a
beneficial component to their patients. Physicians see this as an opportunity to kept up-to-date
on current prescriptions and therapeutic agents, and also allowing those patients who could not
afford some prescriptions, free drug samples which are given out by different companies (Bansal
& Das, 2005). With that being said, a new consensus is occurring that doctors are prescribing
more expensive brands of medication because of "quality." It is an open secret that the
professional associations depend solely on pharmaceutical companies to sponsor their medical
programmes viz., CME's, Conferences, Annual Meeting, Workshops etc. Many junior as well as
senior physicians seek sponsorships or financial aids from these companies to attend national as
well as International Conferences" (Bansal & Das, 2005). As stated above, even pleasure trips
are planned for doctors and immediate family members that are arranged by pharmaceutical
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 7
companies. When doctors are offered all of this, they tend to reciprocate the favor by purchasing
and prescribing the medical drugs from those particular companies (Bansal & Das, 2005). This
then leads to the over-prescribing of medications.
A lot of the prescription usage could be eliminated if doctors informed and educated
patients on how to eat healthy and exercise. This is not a regular practice in doctor's offices,
though. As health care officials go through school, nutrition and exercise are touched on, but a
main area of education goes to pharmacology and the understanding of prescription medications,
as well as the impact the medication has on the body. As seen above in current statistics, the
pharmaceutical company is almost the top spending area in health care costs. These companies
have a lot of power within the United States. Some professionals may see this as a downfall,
because these companies are not interested in the actual health of individuals, rather making
money off of the medications being sold. This then ties into doctors, because of the incentives
doctors are receiving to give out certain pharmaceutical companies products.
Contrary to prescription use, are many new studies being done in the past few decades to
get a thorough understanding of chronic diseases, and diseases in general, in which many
individuals are spending tons of money on prescription medications to treat. Chronic diseases
are the leading cause of death in the United States. These diseases consist of heart disease,
stroke, cancer, diabetes, obesity, and arthritis. Billions of dollars are spent on prescription
medication and treatment approaches to treat these diseases. In 2012, around half of the adult
population had one or more of these chronic conditions (CDC, 2014). Heart disease and cancer
accounted for around 48% of all deaths in 2010 (CDC, 2014). " Health risk behaviors are
unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or
physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 8
illness, suffering, and early death related to chronic diseases and conditions" (CDC, 2014, pg. 1).
Studies done in 2011 found that more than half of adults aged 18 and over did not meet the
recommendations for physical activity, particularly with aerobic exercise, and more than 76% of
these individuals did not meet the requirements for strength training (CDC, 2014). " In 2011,
more than one-third (36%) of adolescents said they ate fruit less than once a day, and 38% said
they ate vegetables less than once a day. In addition, 38% of adults said they ate fruit less than
once a day, and 23% said they ate vegetables less than once a day" (CDC, 2014).
Two other components that play into these chronic health diseases, which are
preventable, are cigarette smoking and alcohol consumption. In 2012, around 42 million adults,
one out of every five, currently smoked (CDC, 2014). The current statistics show that cigarette
smoking is responsible for around 480,000 deaths per year. "Each day, more than 3,200 youth
aged 18 years or younger smoke their first cigarette, and another 2,100 youth and young adults
who smoke every now and then become daily smokers" (CDC, 2014, pg. 1). As aforementioned,
alcohol consumption also correlates to chronic diseases and death. Alcohol is responsible for
around 88,000 deaths per year, and half of which are due to binge drinking (CDC, 2014).
"About 38 million US adults report binge drinking an average of 4 times a month, and have an
average of 8 drinks per binge, yet most binge drinkers are not alcohol dependent" (CDC, 2014,
pg. 1).
All of these behaviors are costing America billions in health care costs, which correlates
to prescription costs and use. Some of these costs in 2010, according to the Center for Disease
Control, included $315.4 billion for heart disease and stroke, $157 billion for cancer, $245
billion for diabetes, $128 billion for arthritis, $289 billion for smoking, and $223.5 billion for
drinking (2010). All of these diseases and health risks can be prevented and eliminated with the
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 9
incorporation of healthier lifestyle habits. Again, many doctors and health care providers do not
provide their patients this type of information while they are sitting in their offices.
Many studies have shown that eating a high nutrient-dense diet, along with exercise
drastically reduce the risk of chronic diseases. Many individuals believe that genetically they are
prone to these particular diseases as they age, and then go on prescription medications until they
end up dying from a chronic illness. Doctors go along with this line of thinking, and never
inform patients about the importance of a nutritious diet and exercise. The specific way a person
lives and their choices with nutrition and exercise outweighs genetics, for the most part.
"Nutrition, exercise and environment simply overwhelm genetics. For example, those living in
rural China have less than 2% heart disease risk, but when they move to America their children
have the same dismal statistics as other Americans" (Fuhrman, 2014). With nutrition,
American's eat processed and packaged foods because of the convenience. These particular
foods do not contain the right nutrients the body needs to fight off diseases. Recently, scientists
have discovered the importance of two specific nutrients that are vital to have in the daily diet;
phytochemicals and antioxidants. Around 12,000 new phytochemicals have been identified by
scientists in the past few decades that has created excitement. "These compounds work
synergistically to detoxify cancer-causing compounds, deactivate free radicals, enable DNA
repair mechanisms, and play a major role in human immune system defenses" (Fuhrman, 2014,
pg. 1). These phytonutrients are only found in fresh fruits, vegetables, beans, and raw nuts.
When these types of nutrients are missing from the diet, chronic disease flourishes.
The typical American diet consists of high saturated fat and high trans-fat foods.
"Americans eat about 40 percent of calories from animal products and 50 percent of calories
from processed foods such as oil, sugar and white flour products" (Fuhrman, 2014, pg. 1). Most
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 10
animal products, especially cheese and milk, are high in saturated fat and cholesterol. Saturated
fat consumption correlates to cancer, and high cholesterol consumption correlates to heart
disease. "Neither animal products nor processed foods contain antioxidants, bioflavonoids,
caratenoids, folate, vitamin C, vitamin K or those thousands of phytochemicals that are essential
for cellular normalcy" (Fuhrman, 2014, pg. 1). Several animal studies were done to prove this
philosophy. Researchers found that when you feed an animal less food, but food that was high in
nutrients, it will live much longer. Also, the thinnest animals always outlive the heavier ones.
Excess calories are harmful to all animals, as well as humans. When humans consume a high
calorie, low nutrient diet, disease flourishes. "When we consume calories without an
accompanying nutrient load, it puts a major stress on the body, and promotes cellular aging. The
ability of each cell to maintain internal cleanliness and prevent degeneration or aging is
dependent on fueling its functions with an assortment of nutrients, including anti-oxidants and
phytochemicals" (Fuhrman, 2014, pg. 1). Exercise also promotes health by allowing individuals
to maintain a healthy weight, increases the body's efficiency, reduces the risk of disease, and
improves the state of mind.
Looking at the benefits of nutrition and exercise, and the importance of implementing
these two components into daily life, some may question why doctors do not touch on this with
higher magnitude. If doctors really started telling their patients about these two components,
especially the thorough details, and patients abided by it, pharmaceutical companies would start
going out of business. Ethically, doctors should inform their patients of everything, especially if
it reduces their disease risk drastically. It is a viscous circle of money and presents between
pharmaceutical companies and health care professionals. Not all health care professionals buy
into the medication side, but a majority does, and that is why prescriptions are one of the top
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 11
spending items in health care. If more patients knew how to actually take charge of their health,
and prevent and reverse disease, many of the chronic illnesses would be eliminated, and
prescription drug usage would decrease drastically. The question is, would this ever happen?
Again, ethically doctors are supposed to look at their patient on an individual basis, and prescribe
the best treatment for the patient. Many believe it is prescribing a prescription medication, and
then telling the patient to come back in six months to a year to adjust the medication, if
necessary. Most doctors are not informing their patients of how to take charge of their own
health, and live a healthy lifestyle. Ethically, the prescription drug companies and doctors are
wrong in their thinking and practice. Every individual deserves a right to be educated and
informed on every treatment approach, and then make up their own mind on which approach
they want to take. The spending in health care could be drastically reduced, if more
implemented the approach of nutrition and exercise, over prescription medication.
Ethical Considerations Between Doctors and Pharmaceutical Agents
Fox 12
Works Cited
Abbot, A. (2013). Ethical issues in pharmaceutical sales. Retrieved on June 20, 2014, from
http://worldofdtcmarketing.com/ethical-issues-in-pharmaceutical-sales/guest-post/.
Bansal, R., & Das, S. (2005). Unethical relationships between doctors and drug companies.
Retrieved on June 21, 2014, from http://medind.nic.in/jal/t05/i1/jalt05i1p40.pdf.
Center for Disease Control. (2014). Chronic diseases and health promotion. Retrieved on June
22, 2014, from http://www.cdc.gov/chronicdisease/overview/.
Center for Disease Control. (2010). Prescription drug use continues to increase. Retrieved on
June 22, 2014, from http://www.cdc.gov/nchs/data/databriefs/db42.htm.
Fuhrman, J. (2014). Eat to live, the basics. Retrieved on June 22, 2014, from
http://mychristiancare.org/eattolivethebasicsarticle.aspx.
Global Research. (2014). Pill nation usa; are american's over-medicated? Retrieved on June
22, 2014, from http://www.globalresearch.ca/pill-nation-are-americans-overmedicated/5367349.
Lambert, T. (2014). A brief history of medicine. Retrieved on June 22, 2014, from
http://www.localhistories.org/medicine.html.
Richards, K. (2014). Your doctor, your pharmacist, and you. Retrieved on June 23, 2014, from
http://www.healthcentral.com/chronic-pain/doctors-161607-5.html.