March 5th, 2018

When the Blind Lead the Blind: The Consequences of Physician Desensitization by Pharmaceutical Marketing

By Jacqueline Zanders

The physician is a rather complicated figure. On the one hand, the doctor is society’s epitome of respectability and expertise, with every fiber of their white lab coat seeming to shine forth light, purity, hope, and a staunch devotion to the Hippocratic Oath. On the other hand, we’ve all heard at least one story of a physician whose unethical practices, motivated by greed, laziness, or, in rare cases, sheer maliciousness, earned them a spot in both the national news and a prison. The dual nature of the medical profession—that those in the field can choose to do lifesaving good or life-ending harm—at times makes it difficult to see or understand that nuances can exist between these two poles. So when I first started doing research on a certain habit doctors have of increasing the prescription of drugs promoted to them by pharmaceutical representatives, regardless of the drug’s possible danger, lack of efficacy, or added cost to the patient, it seemed that there was only one explanation: the corruption of medical practitioners had become more widespread than I’d ever thought possible. It was only after further investigation that I realized the malady gripping the medical sector is not so easily diagnosed.

Pharmaceutical representatives are a commonplace feature of doctors’ offices across the United States. As of late, increasing attention has been focused on marketing strategies in which representatives from pharmaceutical companies appear in hospitals and clinics to talk to doctors, provide food, and promote their new drugs along with offers of payment to give speeches on behalf of the company or to participate in drug trials. One would think that only those doctors who indulged in the last activity—receiving monetary reimbursement for working with “Big Pharma”—would be the ones doling out higher prescriptions of their sponsor’s drugs. But as it turns out, studies have shown that any doctor who even accepts so much as a sandwich on their lunch break from a pharmaceutical representative is likely to become unconsciously biased towards prescribing that representative’s drugs more often, even if they honestly believe that they are not affected by the pitch being made to them.

The plot only thickens from here. Why, one might ask, are doctors so open to listening to these representatives when they come knocking on their doors? Shouldn’t they be wary of even speaking to such people? The answer is that many doctors are actually conditioned throughout medical school to hold representatives in a favorable light. Astonishingly, it is extremely common for pharmaceutical companies to serve as monetary benefactors for medical schools, and in many cases, this means that they can influence the curriculum, subsidize professors’ research, gain access to students via representatives who provide treats, textbooks, and trinkets like branded merchandise, sponsor student initiatives and clubs, and distribute educational materials to scholars. Medical students become comfortable with using pharmaceutical representatives as educational resources whose claims are considered completely reliable and whose presence leads to positive rewards. This is not to say that good relations between the pharmaceutical industry and medical schools have no merit. But when students are conditioned not to even consider the possible corporate bias of the nice person who is providing a gift along with their pharmaceutical company’s business card, they later leave themselves vulnerable to a lack of discernment when it comes to dissecting the truth from praise being sung over a new drug (a drug that might not be any more effective than the cheaper generic version, or is even dangerous when used in the way the representative promotes it).

                  All of this, of course, has serious consequences for patients, who often have no real choice but to trust their doctors’ prescriptions. When a doctor prescribes a drug based on twisted marketing strategies from pharmaceutical companies, patients are not only vulnerable to the needless prescription of certain drugs—for example, the American opioid crisis stems largely from unnecessary prescriptions, with the amount of opioids prescribed per capita in 2015 triple the amount in 1999—but they can also be victimized monetarily, paying enormous sums of money for expensive drugs that aren’t even necessary to treat their illnesses. A 2013 report in The Journal of Law, Medicine & Ethics, for example, found that though up to 89% of 'new drugs' developed by the pharmaceutical industry have no significant therapeutic value for patients (and only 1.3% of revenues go into developing them), they are still marketed heavily as new therapies, earning 25% of the industry's revenues. Doctors who are conditioned to take marketing of these new, expensive drugs at face value and fail to consider other options, like generic, time-tested drugs that are cheaper and more reliable, needlessly burden their patients, especially those in vulnerable communities consisting of the poor and elderly.

Needless to say, these revelations all add up to a rather ugly sum. Thankfully, however, there are some groups that are doing something about it. The American Medical Student Association (AMSA), for example, boasts several programs, including the PharmFree campaign, which aims to educate medical practitioners and students about how to make informed prescribing decisions and avoid bias. Several medical schools have also taken steps to reduce conflicts-of-interest with pharmaceutical companies and to deliver more unbiased and thought-provoking teaching on drugs to their students. But for such efforts to have long-term effects, students, both current and prospective, must take the time to make personal pledges to be thoughtful and critically-minded when it comes to the information they accept as fact and the advice they give patients. Being a pre-medical student myself (who has come into contact with pharmaceutical representatives during shadowing experiences), I believe that it is now more important than ever, with problems like America’s opioid crisis looming tall above us, to ask the important questions. Challenge assertions. Verify claims. If within your power or expertise, propose new actions and regulations. Be observant when effects don’t line up with labels. Stand up for yourself and for the good of the patient, even if the patient is the one inadvertently asking you to do him or her harm. Of course, I’m sure that is all much easier said than done. After all, the physician is a rather complicated figure, with a complicated job. But even if I can’t be a perfect doctor, with every fiber of my white lab coat attesting to my flawless bedside manner and unblemished patient approval rate, I can at least strive to be a conscientious one. And educating myself and others is where that process begins.

The rising generation of physicians and policymakers has the opportunity to change the way that medicine is done in America. We must take this responsibility seriously. Turning over our accountability on this matter to the bottom line of the pharmaceutical industry, either by a lack of scruples or a lack of knowledge, is no longer acceptable. Now we have the facts. Now we must use them.

Jacqueline Zanders is a sophomore at Harvard University. She plans to major in Social Anthropology and aspires to become an oncologist

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