Is it ethical for Pharmaceutical companies to market to physicians?
Is it ethical for Pharmaceutical companies to market to physicians?
Siraj Haq
Gen303F
Prof. Gordana
November 15, 2012
Is it ethical for Pharmaceutical companies to market to physicians? 2
Have you ever wondered why your physician prescribed you a particular medication?
While you may think that your doctor's decision is based solely on the effectiveness and cost of
the medication, you would be surprised to learn that in most cases your doctor's decision is not
purely objective. In fact, in some cases, the course of your treatment is based on your physician's
attitude towards the drug representative of a medication or the gift they received from a
pharmaceutical company. As appalling as it seems, the truth is that about $5.5 billion is spent
annually by pharmaceutical companies to market their drugs to physicians. Pharmaceutical
companies devote 35% of their personnel to marketing. In the year 2001, some 88,000 sales
representatives were sent to doctors' offices by pharmaceutical companies - that's the equivalent
of one representative for every 5 doctors (Angell, 2005, pp. 115-116). Although many advocate
that the use of such practices by pharmaceutical companies is unethical, pharmaceutical
companies boost that they too are a business and have the right to make a profit.
In order to understand the role physicians play in the pharmaceutical industry, it is
important to have some general background information on the industry itself. The
pharmaceutical industry is one of the most profitable industries in the United States. IMS Health
estimates that Americans spend about $200 billion every year on prescription drugs, while
worldwide prescription drug sales amount to $400 billion. It is estimated that these figures grow
by twelve percent every year. Moreover, when income and training expenses are taken into
account, pharmaceutical companies spent $150,000 annually per primary care sales
representative and $330,000 per specialty sales representatives (Fugh-Berman & Shahram,
2007).
Drug reps and their companies use a variety of techniques to manipulate physicians. The
decision to use a particular technique is based on an analysis of a physician's personality and
Is it ethical for Pharmaceutical companies to market to physicians? 3
interests. However, many of the techniques used by drug companies are fundamentally the same
and are based on the norm of reciprocity.
Perhaps, one of the most widely used practices by pharmaceutical companies is the
practice of giving out free samples to physicians. The pharmaceutical industry spends $11
million annually in supplying free samples to doctors (Angell, 2005). This demonstrates the
pervasiveness and popularity of this practice among pharmaceutical companies and doctors. By
supplying doctors with free samples, drug representatives not only gain entry into a doctor's
office but also manipulate doctors into subconsciously prescribing the targeted drug. Free
samples are effective in getting both patients and doctors familiar with an expensive, newly
approved drug. In essence, both the doctor and patient get hooked on the "free sample," and thus,
the patient is almost certain to receive a prescription for the sampled drug. But many patients
also admit to enjoying free samples. Patients are gratified to receive a free sample from their
doctors which may save them a co-pay anywhere from fifty cents to two hundred dollars plus.
Likewise, doctors know the positive effects free samples have on their patients and thus, are
eager for their monthly or weekly delivery of free samples (Fugh-Berman & Shahram, 2007).
In a manner similar to free samples, small gifts are able to influence the prescribing
habits of doctors. Small gifts include foodstuffs and promotional items like notepads, pens, and
other office trinkets with the product name emblazoned on them. Studies by the Office of the
Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) indicate
that virtually all doctors accept small gifts from drug companies. In fact, many physicians list
small gifts as their top reason for meeting with drug representatives. These small gifts are often
called "reminder items," since they are not only modes of advertisements but also reminders of
Is it ethical for Pharmaceutical companies to market to physicians? 4
the warm, friendly relationship between the doctor and the drug representative (Katz, Caplan, &
Merz, 2003).
Then there are the larger gifts. An editorial in the USA Today painted an extravagant yet
accurate image: "Christmas trees. Free tickets to a Washington Redskins game, with a
champagne reception thrown in. A family vacation in Hawaii. And wads of cash" (Angell, 2005,
p. 128). Gifts such as these rely on the norm of reciprocity. When a gift is received, it poses a
sense of indebtedness on the recipient. The recipient feels obligated to reciprocate because it is
socially acceptable to do so. Those who do not reciprocate are perceived with disgust and
negative attributions in our society and are often times classified as "moochers," "ingrates,"
and/or "free-loaders." Thus, some doctors inevitably feel the need to directly reciprocate to the
drug representatives and their companies who have provided them with all these gifts. Physicians
do this by prescribing the benefactor's products (Katz, Caplan, & Merz, 2003).
Drug companies also manipulate the prescribing habits of physicians by "masquerading
marketing as education." Most states require doctors to receive continuing medical education
(CME) throughout their career to maintain their licenses. These credits can be earned by
attending meetings and lectures. Clever pharmaceutical companies have become notorious for
sponsoring and funding such meetings, lectures, and conferences. In 2001, pharmaceutical
companies paid over 60 percent of the costs of continuing medical education. Likewise,
professional societies, like the American College of Cardiology, are now partly funded by drug
companies. At these annual meetings, drug companies present their own symposia - with free
lunches and dinners - to promote their companies' latest drugs. According Marcia Angell, former
editor in chief of The New England Journal of Medicine and a physician trained in internal
Is it ethical for Pharmaceutical companies to market to physicians? 5
medicine and pathology, meetings of professional societies have now become a venue for
marketing drugs to physicians:
With so many bribes being pushed upon physicians, it is no surprise that studies show
that doctors prescribe more of the sponsors' drugs after these meetings (Angell, 2005, p. 148).
While many are disgusted by the extent to which pharmaceutical companies go to
deliberately manipulate physicians, pharmaceutical companies argue that their aim is not to
manipulate doctors but rather to inform them about their latest products and update them on the
use and/or success of their drugs. According to Dr. Richard Levy, current Director of Business
Unit of Viral and BioMolecular Clearance Technologies, pharmaceutical marketing is a way not
only to educate physicians but also a way to promote innovation within the industry. He claims
that pharmaceutical marketing allows physicians to learn about the new treatment options
available to patients. He adds that if physicians are not informed about new treatment
opportunities, then there is no innovation within the industry and the industry essentially remains
at a standstill. Furthermore, pharmaceutical marketing allows companies to present the approved
uses of their drugs along with side effects. It allows companies to present any new findings
regarding the drug to doctors so that that information can effectively be used by doctors when
writing prescriptions. This in turn helps improve the patient's quality of treatment because
doctors are more informed about the drugs they are prescribing - they better understand the
course of the drug, the side effects of the drug, the risks associated with the drug, and the
expected end result of the drug. In this way, pharmaceutical companies claim that their
marketing is a valid means of education for doctors.
Another argument used by advocates of pharmaceutical marketing is that pharmaceutical
companies are a business and like any other business have a right to make a profit. If companies
Is it ethical for Pharmaceutical companies to market to physicians? 6
like Giant Eagle, Pepsi, and Dove can promote their products, why can't pharmaceutical
companies? While in recent years the government has issued regulations on pharmaceutical
marketing, pharmaceutical companies argue that they spend billions of dollars on drug
development and therefore, pharmaceutical marketing helps to break-even and promote scientific
innovation. Specifically, drug companies invest a minimum of $4 billion and up to about $11
billion on the development of a single drug in a trial and error and intense testing period that can
take about 10 years (Collier, 2009). Therefore, the industry claims that they are simply trying to
make up the costs of drug development. Every business seeks to earn a profit and pharmaceutical
companies also have the right to run a profitable business.
Despite claims that pharmaceutical marketing is an educational technique and completely
legal, many critics complain that the practice is unethical and goes against morals. Critics argue
that the effects of pharmaceutical marketing are barred by patients. Patients place their whole
trust in doctors and expect them to alleviate their pains and illnesses. However, little do patients
know that the course of their treatment is all an exchange between a business (the pharmaceutical
company) and a client (the physician). The patient is then so innocent in assuming that his or her
doctor holds his or her best interests closest to heart. Although many doctors aim at providing
their patients with the best care possible, in many cases, they subconsciously prescribe a
medication over a more effective medication due to pharmaceutical marketing. As a result,
patients may end up paying more for a more expensive yet less effective medication.
In essence, it is wrong to manipulate physicians because in extreme, rare cases they run
the risk their patient's life due to a wrong prescription. But moreover, patients pay massive copays to see doctors in hopes that the doctor will prescribe the most effective medication to them.
But in reality it does not always work out this way.
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While many patients may not be willing to accept the truth of the relationship between
their physician and the pharmaceutical company, I witnessed and discussed the truth of the
matter with my physician, Dr. Harris Aziz, first hand. At my doctor’s appointment on October
28th 2012, I quickly spotted my Dr. Aziz’s matching LYRICA pen and notebook. I casually
asked him if he ever had to buy his own pens or notebooks, since every time I came in he had a
fancy, branded pen. He jokingly smirked and said, “That’s one the perks of being a doctor.” That
led us into a whole discussion about the pharmaceutical company. While I am sure that he did
not reveal his experiences and encounters with the industry in their entirety, he did seem to show
preference to certain drug reps. Therefore, this led me to believe that even my physician was a
part in contributing to the success of the pharmaceutical industry. How much the drug reps
impact his prescribing is a question that I will never have the answer to but will remain skeptical
for the many years to come (H. Aziz)
In an effort to sustain a $200 billion dollar industry and one of the United States
most profitable industry, pharmaceutical companies have developed tactics to manipulate
physicians' prescribing habits in order to increase profits (Angell, 2005, p. 3). Such tactics can be
as small as free samples and pens or as extravagant as vacations and silk ties. So the next time
you go to your doctor's office, take a moment and look around - notice any posters promoting a
particular medication on the wall, notice the pens your physician uses, notice any note pads with
drug names on them, notice your doctor's attitude regarding the medications he or she prescribes
you - and then decide for yourself whether your physician contributes to the success of the $200
billion dollar pharmaceutical industry.
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References
Angell, M. (2005) The truth about the drug companies: How they deceive us and what to do
about It. New York: Random House Trade Paperbacks.
Collier, R. (2009). Drug development cost estimates hard to swallow. Canadian Medical
Association Journal, 180(3), 279-280. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630351/
Fugh-Berman, A., and Shahram, A.. (2007). Following the script: How drug reps make friends
and influence doctors. PLoS Medicine 4 (4), 621-625. Retrieved from
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0040150
H. Aziz, personal communication, October 28, 2012.
Katz, D., Caplan L. A., and Merz J. F.. (2003). All gifts large and small. American Journal of
Bioethics 3 (3), 39-46. Retrieved from http://repository.upenn.edu/bioethics_papers/51/