An interesting article appeared in USA Today concerning the influence of pharmaceutical advertising on prescription practices by physicians. The survey performed by the Kaiser Family Foundation and the Harvard School of Public Health reported that prescription drug ads prompt nearly a third of Americans to ask their doctors about a specific advertised medicine. In turn, 82% of those who asked their physician eventually received a prescription. Furthermore, 44% of the physicians wrote a prescription for the asked drug while 54% recommended a different prescription. 30% recommended an over the counter medication.
Another interesting series of events occurred this past month involving Dr. Robert Jarvik, a pioneer of the artificial heart. Pfizer, the maker of the most popular selling statin Liptor, hired Dr. Jarvik 2 years ago at a price of over 1 million dollars to be a spokesperson for Lipitor. Since then, he has appeared in numerous ads depicting him performing some type of athletic activity such as rowing and ultimately ending the ads with an endorsement for the drug. Several issues were raised. Is it ethical for a celebrity physician to be hired by a private for-profit company to promote a product directly to patients/consumers? Dr. Jarvik is a physician but he is not a cardiologist, does not have a license to practice medicine, and cannot prescribe medication. Is it ethical for him to be promoting Lipitor? Dr. Jarvik also is not a rower and a body double was used for one of his ads. Is this false advertising? The ads were so controversial that the House Energy and Commerce Committee launched an investigation prompting Pfizer to cancel the ads one month later.
Although these events and the recent survey are disturbing, they should come as no surprise to the many of us who deal with the medical industry on a regular basis. I would imagine that most physicians and patients are aware that pharmaceutical companies' interests are not always the same with our personal interests. After all, pharmaceutical companies are just like most other businesses--they want to make money while providing a worthwhile product. The issue becomes which aspect of their business is more of a priority-- sales of the drug or the effect of the drug. The Kaiser survey revealed that only 47% of Americans have a favorable view of pharmaceutical companies with 70% believing that drug companies are too concerned about making a profit than with helping people.
On the flip side, given the reality of today's resources, we need pharmaceutical companies and private industry dollars to continue to develop new ways to diagnose and treat disease. The federal government (NIH/NHLBI) and non-profit organizations cannot fund an adequate number of drug research and development programs. We as a society have benefited tremendously from thousands of products that have come to market from for-profit companies. For example, the death rate from heart disease fell ~33% from 1994 to 2004 largely in part due to major advances in medical treatment. One huge advancement in that medical treatment was the development of statins by private industry.
As a physician, I have often found the business of medicine to be contradictory. One cynical way to look at drug companies is that they are making a profit on the misfortunes of others. A more optimistic view would be that they are making money on improving the health of others. (I suppose you could also apply the same views to doctors.) Whichever view you prescribe to, there is no doubt that there exists some conflict of interest in the pharmaceutical industry. And given this inherent conflict of interest, I don't think that the responsibility of what's best for the patient can be placed in the hands of the drug companies. The federal government has and certainly can do more to "regulate" the industry, but I honestly don't have the full confidence that our government can be free without significant conflict of interest as well. Just look at how powerful the pharmaceutical industry is as a lobbying group. I think the largest burden of responsibility about the correct use of these medications falls on two groups of people: doctors AND patients. In the Kaiser survey, 81% of the people had a favorable view of physicians. That places an enormous amount of responsibility on doctors to do what's best for their patients. Doctors have been heavily targeted by drug companies to alter their prescribing patterns through a variety of programs and "incentives", and this too has led to changes in prescribing practices. However, inherent in all physician training is the duty and responsibility to serve the patients' best interest first. I don't think drug company sales representatives have that same type of training.
Patients also have a significant responsibility concerning the use of medications. After all, they have the final say as to whether they will ultimately take it. The more educated a patient is about their disease, the better I think their overall care will be. Some physicians don't like having the patient ask too many questions, but I am not one of those. I am more uncomfortable with the patient who says, "You're the doctor. Just tell me what to do," as opposed to the one who shows interests and asks questions. I think informed patients have better relationships with their doctors, a better understanding of their disease, and have better outcomes with treatment. I have no significant issues with drug companies marketing directly to the public so long as the information is truthful and portrayed honesty. In fact, these ads can increase public awareness of diseases. And, I certainly have no problem with patients asking about a particular drug that they saw on TV. My job as a healthcare provider is to render my best medical opinion, suggest any alternatives, and help patients make decisions about what's best for them. This may or may not lead to a new prescription.
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Published On: March 06, 2008