Welcome back to Contemplative Being!
Today I would like to talk about something I suspected but
did not really know much about prior to last night when I decided to watch Last
Week Tonight with John Oliver for the first time. I’m not saying the show is
like an encyclopedia but it got me thinking about the issue so I did a bit more
digging although I would still not consider myself an expert on the matter by
any means. The topic covered in the season two premier episode was that of pharmaceutical
sales and payments that pharma makes to doctors.
I imagine that most people know that medical sales are a well-established
career. I admit that I do not know anyone that works in the field but from my
understanding the job is about traveling around to different doctors’ offices
and telling the doctors what new medication and medical equipment/supplies
their company has recently developed and leaves the doctor with samples of the
medication. Given my assumption of how the job works I was surprised to hear
from the show that most people that work in medical sales have no medical or
scientific background at all. This is not necessarily a problem because people
of course can learn about what they are being made to sell. What really caught
me off guard is that the sales representatives often use other means to
encourage doctors to prescribe their company’s products. The range of
techniques used to encourage doctors to prescribe their products goes from
bringing free lunches to the office sometimes on a regular basis to luxurious
hotel and travel and even direct payment of cash. Pharma has realized that not
all doctors are easily motivated by the allure of more money so they have gone
as far as recruiting some doctors and refers to them as “thought leaders”. It
is an appealing title to say the least. The role of a “thought leader” is to
talk and present to other doctors using a script and presentation materials
that the pharmaceutical company has provided to them in an effort to persuade
other doctors to prescribe their products. The idea here is to fool other
doctors to prescribe particular drugs based on an unbiased recommendation from
a doctor when in reality it is just another sales pitch.
At this point I started to wonder how the pharmaceutical
company knows who prescribes what. It makes perfect sense but I never really
thought about it, the data from those computers that your pharmacy uses to log
your prescription is sold to the pharmaceutical companies. This means that
whenever you fill a prescription the pharmaceutical companies know what the prescription
is for and who prescribed it. This allows pharma to track the prescription
history of every doctor. With this information in hand the company is able to
pick up the phone and place a call to a doctor that may have agreed to prescribe
a drug but ended up prescribing a competitor’s offering to remind them of whatever
agreement they had paid for.
When Obama first unveiled his health care reform plan the
first thing the opposition said is that the government should not get to decide
on the treatment plans of patients. It appears that it is pharma that gets to
decide in reality. Is it ethical for pharma to be able to bribe doctors into
pushing the products of whoever paid them the most? I am not sure what you
think but I do not want my doctor prescribing something to me because the manufacturer
paid him to. I think doctors should prescribe based on what their knowledge and
experience has taught them would be best for my particular situation. I think
this ties back to my earlier post titled Free Stuff about governor Chris
Christie receiving gifts in exchange for encouraging the Port Authority to
accept a proposal from his friend.
As public administrators it is our responsibility to ensure
that the people we serve are given the information they need to be able to make
informed decisions. There are laws in place prohibiting some of the strategies
that pharma uses such as paying kickbacks to doctors who prescribe their drugs.
Pharmaceutical companies have paid billions to the federal government to settle
cases over the past few years but that does not seem to faze them. According to
the show pharmaceutical companies spend significantly more on marketing than
they do on research. There is nothing wrong about a company wanting to make a
profit but when it crosses the line to kickbacks and bribery it is
unacceptable. One of the outcomes of Obama’s health care reform was the
creation of the Open Payment website
where people can search for their doctors and find out how much money they have
received from pharma. One of the ethical principles at play here is that of
motivated reasoning. Pharma like most corporations in the U.S want to make as
much money as possible and the way to do that is by selling their products.
They are so motivated that they have lost sight of what is right and wrong and
without further reform they are likely to continue going down this path.
Ethical fading has taken hold because they continue going down the path and
gradually go deeper losing sight of what is right. Because of this more
settlements are likely to come as paying fines is seen as a cost of business
because the amount they make by breaking the law is worth the price. It seems
like we have a long road to travel still before doctors are truly able to make
decisions about our health without external forces working to manipulate them. Don't get me wrong I think pharmaceutical companies are increadibly important and have helped the overall health and longevity of us all. I just think they need to get back on the right path.
Thanks for reading, come back next week.
References and Related Links
Oliver, J. (2015, February 8). Last Week Tonight with John
Oliver: Marketing to Doctors (HBO). Retrieved HBO. February 19, 2015, from https://www.youtube.com/watch?v=YQZ2UeOTO3I
Silverman, E. (2015, February 9). Does Pharma Money Mix With
Cash Receptors in Your Doctor’s
Wallet? The Wall Street Journal. Retrieved
February 19, 2015, from http://blogs.wsj.com/pharmalot/2015/02/09/does-pharma-money-mix-with-cash-receptors-in-your-doctors-wallet/
Open Payment Website - http://www.cms.gov/openpayments/
Good take on this week’s blog on pharmaceutical sales. This business is a huge business and most of the pharmaceutical sales reps I know have business and marketing degrees and just happen to fall across it after college and as you stated, it makes big bucks. The business of it all is a booming business but sometimes causes ethical issues. As you stated I would want my doctor prescribing medication based on what has worked and what they believe in not based on who he owes to fulfil a deal. It’s quite sad when you think of what some doctors have started to do, and in no way do I think all doctors are victims of this, but for those that are, it’s sad. I think this just brings more need for awareness of people to research more and ask more questions and not to just take a word whatever the doctor says or prescribes. I know if I ever have to receive meds for any reason I always do my own research for this very matter. I need to make sure that what I’m taking will help and has been approved and shown to do so. The reality is that everyone is not as up on this as they should and many are being taken advantage of.
ReplyDeleteI think that it is sad that the medical field has been infiltrated by agenda pushing in the name of a persons health and welfare. A person looks for a doctor to be objective and provide care based on the best possible solution for the patient. a person does not want a doctor to base care on which big pharma company paid the most money in gifts and incentives. Some of these pharmaceutical reps are just like lobbyist who agenda push in government in order to promote perspectives and gains conducive to big profits. Doctors have a duty to perform act in an ethical way and the standard is high because they deal with people and a person's health. The healthcare field especially should not be a industry that is concerned with capital gains insomuch that the focus should be helping people.
ReplyDeleteHello Ben! I enjoyed reading your blog post for this week. I think that the subject you chose to write about is one that not many people think about, I know I do not. You brought up a lot of good points regarding Pharma and ethical concerns. The relationship between doctors and Pharma is similar to the relationship between politicians and campaign supporters. As much as we may not want to recognize, “legal bribery” occurs every day from large settings such as doctors and Pharma or a stay-at-home mom with her own business giving you samples so that you buy her product.
ReplyDeleteI do have to admit that this particular subject is something that does not come to mind when I see a doctor. I automatically assume that the doctor will prescribe whatever he/she knows will be the best course of treatment for me. I was not aware of the “Open Payment” website but know that I am, I am definitely looking up my doctors. Thank you for writing about such an interesting topic.
Excellent read Benjamin!!! I watched this movie once about a guy who got rich off pharmaceutical sales. It was amazing to see just how much is involved in pushing a product to the limits. The ethical standpoint for doctors is really on them. I would want my doctor to give me the best drug possible for my treatment, but I do know everything is a business. Hopefully the drug that is being backed is one of the best or even the best. It would definitely be unethical for your doctor to give you a drug only, because he is being paid the most for it.
ReplyDeleteThis was a great and though provoking topic. In this high competitive capitalistic system there is always going to be these type of ethical concerns when it comes to healthcare. The great thing about our system is that it leads to great innovation and has provided us with some great drugs for a variety of ailments. But of course the downside to this is what you explained in the article. I think a great first step is the clause in the Affordable Care Act where we can look up what certain doctors get from pharma companies . It is this type of transparency that is needed to prevent the unethical behavior that goes on in the medical field. Money is a powerful motivator so we absolutely have to have regulations and oversight. At the same time I think we can take some comfort in knowing that since these drug companies know they will get a huge return on their investment if their drugs are successful, we are getting some medicine that will make a difference.
ReplyDelete