Welcome to the latest installment of my water is wet series of posts...well it isn't really a series but I've been made fun of in the past for discussing articles which examine topics of which the answers are "obvious." Todays post will not differ from that trend in the slightest! I say this because I am quite sure you are already aware of the answer to the question posted by the title! Or are you? Yes, you probably are :)
Nevertheless, today we will be discussing an article recently published in the jounal PLoS One titled "Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia." In this succinctly titled article the authors were trying to provide some quantifiable data looking at whether or not gifts from pharmaceuticals had an effect on the way physicians prescribe medications to their patients.
Water Is Wet.. I mean Giving Gifts Affects Human Behavior
This isn't exactly an earth shattering idea, I mean... why do people give gifts in the first place? It's usually to get something in return, even if that something is just good will from the person gifted the item. So, it shouldn't come as much of a surprise to anyone that when a pharmaceutical company gives some fancy swag to a doctor (or buys them lunch, dinner, breakfast, a coffee... really anything) its going to change how the doctor views that particular company, as well as how the doctor thinks about the product they are selling. [2]
The whole concept revolving around this conflict of interest of interacting with pharmaceutical companies and the effect it has on how doctors prescribe medication has been studied quite a bit in reality. [3], [4].
Ask physicians if they think other physicians are affected by gifts from pharmaceuticals and 77% of them will tell you yes! [5]. Ask a physician if they think it effects them... well they will tell you that it doesn't (and they will be wrong!) Further still, many believe that smaller gifts don't affect any physicians behavior at all. [6] This is just an illustration of peoples inherent inability to identify their own bias at times. I am sure I fall prey to this in many circumstances as well, so its hard to fault the doctors for thinking they are not themselves a part of the problem.
What Did The Researchers In This Publication Look At?
The authors of this article were studying Medicare claims made by physicians and their patients in Washington D.C., they used these claims and the information available therein to quantify the relative amounts of what drugs were prescribed, the total amount of money that the prescriptions cost, and what the ratio of name brand and generic drug prescriptions were. They then correlated this data with pharmaceutical marketing data available through either Washington D.C's Department of Health AccessRx program, which requires pharmaceuticals to disclose their marketing and promotional activities to doctors in the D.C. area, or another database called Open Payments.
What Did They Find?
Not shocking to anyone, they found that the overall cost of the claims filed by physicians in a variety of specializations were higher for those who had received gifts from pharmaceutical companies (blue) then for those who had not received gifts (red). The authors report that on average a claim filed to medicare for medical care by a physician who had not received a gift was $85, while claims filed for care by physicians who had recently received pharma swag were $135! An increase of $50 per claim on average! That's quite a steep increase!
Beyond this the authors also showed that the more expensive the gifts were that the doctors received (ooohh some over $500) the more expensive the claims ended up being, and also the more likely a doctor was to prescribe a name brand medication over that of a generic one.
What we can take away from this data is that there is a correlation between doctors receiving gifts and more expensive healthcare costs.
Some Other Thoughts From The Authors Discussion Of The Data
You might ask, how do I know that the more expensive gifts are not just being targeted to doctors who prescribe the most name brand drugs, rather than the prescribing of the drugs resulting from receiving the gifts. The authors concede this point, we don't. However the end result from this line of thinking doesn't matter, because the gifts in this case are still being given to reinforce the behavior of those doctors and keep them writing more expensive prescriptions.
So next time you go to your physician and they prescribe you the name brand version of a medication, is that because it truly works better than the generic (this is sometimes the case) or because they recently had a fancy dinner? As someone who works for a pharmaceutical company that REFUSES to engage in this sort of promotional material (likely to the tune of smaller profits, but it's worth it to not be shady) I recognize that this sort of promotional behavior is not good for patients and not good for healthcare in general.
If only more companies felt that way.
At least better educating doctors on this phenomenon is a start in the right direction!
Sources
Text Sources
- http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186060
- https://www.ncbi.nlm.nih.gov/pubmed/27322350
- https://www.ncbi.nlm.nih.gov/pubmed/8309031
- https://www.ncbi.nlm.nih.gov/pubmed/10647801
- https://www.ncbi.nlm.nih.gov/pubmed/2398609
- https://jamanetwork.com/journals/jama/article-abstract/196871
Image Sources
All Non Cited Images Are From Pixabay.com, Flickr.com, Pexels.com, or Wikipedia.com And Are Available For Reuse Under Creative Commons Licenses
Any Gifs Are From Giphy.com and Are Also Available for Use Under Creative Commons Licences
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Probably the biggest kinds of bribery come in the form of trips, lunches, and conferences. The most disturbing part is that disclosure only makes matters worse.1
Some of the doctors I know are so overworked and feel so underappreciated that things like pens or mugs might do the trick.
1 Daylian M. Cain , George Loewenstein , and Don A. Moore , "The Dirt on Coming Clean: Perverse Effects of Disclosing Conflicts of Interest," The Journal of Legal Studies 34, no. 1 (January 2005): 1-25.
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This is ... depressing.
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The realm of nutrition was of great interest to me at one stage. The more I dove into the literature, the more confused I became due to the contradicting publications. My Dad then gave me sound advice: “follow the money trail and the truth will be revealed".
Since then I always pay attention to who funds the studies I read. If the sponsor stands to benefit, I always take the results with a pinch of salt.
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This is a hugely important topic and many whistleblowers have already come forward with shocking exposures of the industry's criminal behaviour - including regularly paying for drugs and prostitutes for some doctors the US to bribe them to prescribe their drugs.
I really suggest reading through these 2 posts from my whistleblower series if you haven't already:
https://steemit.com/health/@ura-soul/the-whistleblowers-series-1-pharmacuetical-professionals-expose-the-massive-criminality-of-the-medical-industry
https://steemit.com/health/@ura-soul/the-whistleblowers-series-18-top-drug-company-sales-rep-i-was-trained-to-mislead-doctors-and-the-public-legal-drugs-are
Also - on a tangent - I'm reaching out to all my followers who have significant Steem Power to ask them to consider voting for me as a Steem witness - as I need the votes to boost me up the ranks and that helps pay my costs and funds exciting projects I have planned to help grow Steemit.
My witness application is here. Cheers!
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It worth a upvote (though my upvote carry no rewards).
By the way, why in this earth the researchers had the idea to do research on such topics!!
Considering normal human behavior, it is not unusual phenomena. Personally, if get some give from someone, I can't take rest unless I can return some favor. Interestingly, I am a doctor by profession and after finishing my MBBS, I am listening this issue. Obviously, I have seen some doctors or teachers who are using MR (medical representative) of various pharmaceutical company shamelessly. And giving return the company in the form of prescription without considering the effectiveness of drugs of those company.
I, personally, when am visited by company representative, when they are asking if I need any special favor or "things", I simply turn them down. I know a good number of doctors who also do the same. But different types of doctor also present in our community.
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I appreciate every upvote, especially when they come along with a thoughtful comment like yours here. Rewards are what ever, chatting with people is more fun anyway.
Because some people (physicians) won't believe they are susceptible to the biases with out data to back it up.
Yup.
I am sure most doctors have a strong moral code and do that, however others just don't see the issue. Research like this just might convince them. Or perhaps it will convince the general public to get mad enough to try to institute policies making sure this isn't allowed.
Some Pharma companies are always going to try to sweeten the deal for doctors with regards to their drugs, making this as difficult as possible will result in more consistent care for people over all IMO.
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All Pharmaceutical company have strategy. They target the doctor just after getting their graduation. I can remember, in early 2012, while was doing my internship with other friends, we were invited in various events where there were general gift packs, restaurants where buffet were arranged with delicious food item, fantasy park to enjoy different rides etc. Personal gift was also different from company to company starting from pens engraving company name to more costly gift.
Those gift also varies according to the position of the doctor. Those who have more option to right medicine , those were given more valuable gift. Shockingly, some of our senior were so sold to those company that they used cut prescribed drug from juniors prescription and replaced it with his/her favorite company's drugs. Professors levels doctors were offered to visit outside country where company used to bear all the expenses.
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That is really messed up IMO
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Nice article. I know my Dad and his office has gotten a lot of perks from pharma companies in the past. NY regulations have reduced these perks substantially, but they are still an issue.
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I wonder if he would acknowledge that the perks affected the medications he prescribed. The data available from the literature indicates that he would likely not be able to see the bias in his own prescribing.
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I just try to find the medication they can afford. Sometimes these companies (often to promote their product) will have samples. For an asthmatic who is being denied mediacation after medication from an insurance company, sometimes those samples could literally be a life changer until they qualify for something else. If the studies are sound for a companies drug then I may be more inclined to read the literature on that drug. That could bring bias. However, at the end of the day my main goal is to have a patient be compliant with a medical plan, not a specific drug if multiple options are available. Generic is fine with me for a majority of drugs.
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These are the innocent examples, free samples and such aren't the issue. Its with pharmaceutical reps taking doctors out for dinner to promote a drug that introduces real bias, or giving them merchandise (mugs, water bottles).
If there is insufficient data to support the drug then yeah you shouldn't bother with it. I can't speak to what all companies do, but where I am at now (and we are small) we really strive to understand as much about how a compound works before even thinking of moving forward into a clinical trial. So when something does get submitted for approval, there is a strong set of publications which go along with it.
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according to me, the pharmaceutical company and physician therie is cooperation. because it is impossible for a pharmaceutical company to give gifts without a specific purpose.
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Well of course, the companies are trying to get the doctors to prescribe their drugs. They are relying on the doctors not recognizing the conflict of interest, and it is clear that many either do not recognize it, or choose to ignore that fact. The whole practice needs stopped.
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in service to patients is still less. this is still happening in Aceh. even they sell expensive
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Thanks for bringing up the topic!
And unfortunately that is the tip of the iceberg. Those acts are so common, that even at times they are initiated by the Dr himself, asking for specific compensation in return. That no longer classifies as a gift, it's seriously a bribe!
In our region here, the effects might be further worse, with Drs prescribing "unneeded" medications for some patients. We are talking oncology cases!
Sadly in a profession such as medicine, where ethics and integrity are much needed, I believe many Drs just forget about their oath.
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That is pretty horrifying and depressing.
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Do you remember the criminal case that was brought against Pfizer for fraudulent marketing of the painkiller Bextra? I first heard about this on the CNBC show "American Greed."
The drug was part of a "revolutionary" class of painkillers known as Cox-2 inhibitors that were supposed to be safer than generic drugs, but at 20 times the price of ibuprofen. But medical studies, including some done at Pfizer, showed that the drug posed an increase risk of death from heart attack or stroke. In 1991, the FDA ordered that Bextra could only be sold for a very limited purpose (arthritis and menstrual cramps). It further ordered that Bextra could not be prescribed for acute surgical pain.
Not only did Pfizer ignore that, its sales managers engaged in an aggressive marketing campaign, paying off anesthesiologists, foot surgeons, orthopedic surgeons and oral surgeons to become educational advocates for the drug. At least one Pfizer manager wrote a sales pitch for doctors to use with their patients, claiming that the FDA had given Bextra "a clean bill of health" all the way up to a 40 mg dose. That was twice what the FDA actually said was safe.
Internal company documents show that the fraud included a multimillion-dollar medical education budget to pay hundreds of doctors as speakers and consultants to tout Bextra.
http://www.cnn.com/2010/HEALTH/04/02/pfizer.bextra/index.html
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Some companies have done some shady shit. I don't know how revolutionary cox-2 inhibitors are/were at the time. However the issues they have are present in any NSAID, including ibuprofen.
Altering the tolerable dose is unacceptable behavior, that should have been punishible with large fines and jail time... Though I doubt it was.
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You're right. The top execs were never really prosecuted. News reports at the time decried the excuse as being "Pfizer is too big to fail."
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Nothing is too big to fail, no executive too powerful to jail.
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Really good post!!
Sure it is fairly obvious that doctors are being incentivized to prescribe specific drugs, but the key for me is why this is happening, whose fault is it, and whose duty (if anyone) is it to stop it?
I am surprised there haven't been more 'Big Pharma must go' responses here - just the one, where the poster didn't seem too objective, as you noted...
I don't think Pharma companies are bad. Many are publically held, all of the large ones are, and they have a duty to their shareholders. The impression I get is:
A key problem in my view is also the general public, who by and large want everything but are not prepared to pay for it. There seems to be an expectation that companies develop new treatments and then just give them away - that is not a sustainable model
On the positive side I am noticing a slow move towards new models that are outcomes-based - companies get paid for outcomes, not pills. This makes sense, but I think there is tons still to be worked out and it will at best be a series of very slow steps
Could go on forever, but I don't actually know much about this - will stop now before I say something totally wrong...
Cheers
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Good article.
Another problem is pharmaceuticals being advertised on tv. I have personally heard physicians on conference calls I've been on complain of patients that come in and demand a drug they saw on tv. When the doctors tell them they don't need that drug, the patient demands it or they will find another doctor.
My unprofessional approach to pharmaceuticals is to get diagnosed by a competent doctor, take the medication as recommended after you have discussed with your doctor what the side effects might be, search information on dietary changes and natural supplements that might help that condition, try only those things that are safe to restore health.
When you are under a doctor's care, If there is a supplement that you want to try, don't hide it from your doctor. Doctors tend to tell patients that they don't need that supplement. But the question to ask your doctor is: "Are there any contraindications for me to take this supplement?" And let your doctor see the ingredients of the supplement. Your doctor can let you know if there is anything harmful in it.
There is a lot of information on the internet. Not all of it is true. Be sure to search for agreeable and disagreeable information from credible sources. Do your homework and read from many sources, and don't believe everything. Your and your family's health is important.
And don't forget to pray.
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Your described course of action with regards to all of this, seems like a very logical and smart path to take. I understand how many drugs work, and what many are for. I understand many things better than my physicians and we often spend time in my checkups with me lecturing them on mechanism of one thing or another. Yet still, I don't decide what drugs I need or how much I need, I leave that to them and always try their prescribed course of action.
I don't think there should be drug advertisements at all. Leave that to physicians. The average person lacks the training to effectively self diagnose.
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Pharmacists have also told me that it is common for them to have to fix errors doctors have made in their prescriptions. It is important to have a competent pharmacist.
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Indeed they are essential to check for drug interactions with other medications already being taken.
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True, water is wet, but it is certainly interesting to see the extent of the influence this comped stuff has in the medical doctors when it comes to prescribing a drug. Pretty high, it would seem!
Very interesting post, @justtryme90, and kudos on being part of an organization that strives to stay away from shady practices!
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I hope they will maintain these practices as they grow. The company is small but I can see based on the research going on that they will become a big deal in the future. They have a real patient first mentality and aren't concerned with the biggest profits possible. I hope that will drive them to successes that greedier companies would fail to achieve.
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Really great story 😀
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My father is a doctor. God I miss all the swag and trips on 5 star hotels he used to take me when I was a child. And I loved all the freebies; food, pencils, mags, notepads, watches, all kinds of shit. We even got a expensive laptop in 2000 XD
Unfortunately the good swag has been seriously cut down in my country. Now it's only cheap pens and stupid shit. And no free trips for family members, they now have to pay :(
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Sounds like you have first hand experience why this is a problem. Sure the swag is nice, but it certainly would have biassed your dad for one drug or another. This doesn't mean those drugs were necessarily bad, but perhaps not the most affordable for his patients.
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"but perhaps not the most affordable for his patients."
well unlike the US, we have free healthcare for almost everyone, and true there had been plenty of abuse in the system. I guess the ones who ended up paying the bill are the taxpayers of germany and other E.U countries XD
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That doesn't fix or change anything... :(
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This is a quite interesting topic and I strongly think it does. 5 years ago Turkey was having a lot of problem about this topic. They were sending holiday tickets all 5 stars hotels , Huge plasma screen Tv's and if you are slighlty famous doctor with his/her own clinic then even bigger stuff was coming. However thankfully goverment regulated a quite strict law inorder to prevent this bribery it is hard to see things like that in Turkey anymore but I still think companies doing it instead of doing more obvious way they turned this system in to real bribery but as I said I never seen a doctor got punished for doing this.
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Yep, huge conflict of interest issue. Thanks for the comment. Hopefully eventually people around the world say enough is enough. It sounds like some governments are, but not all and others not enough.
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Well it was quite intriguing topic thanks for mentioning this some people may forget about this because they aren't in pharmaceutical sector however I'm pretty sure huge percentage of people know about this but they don't care much I'm quite shocked by the 18 percent shift on the decision of the doctors when we think about the huge economy created by drug companies 18 percent makes a quite big difference.
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Yep, it's definitely huge.
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Hello @justteyms90
I strongly gifting influences most doctors prescription decision. Yes as much as that is true, there are exceptions — people of high moral inclinations – would rather not receive such gifts. Unfortunately, they only constitute a tiny fraction of the community.
This is indeed a thought provoking post. Thanks for sharing.
@eurogee
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Thanks for taking a read :)
Right we can't rely on the morality of the physicians. We have to as a society say that this gifting is unacceptable and enforce punishments for it.
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Yes you are very right.
@eurogee
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Great post @justtryme90 very usefull article love it..i got more from your blog.
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Thank you for reading it @cammelya, have a great day!
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Very good my post.
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Thank you.
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friend once please visit to my post.
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Yeah i think it has a lot of effect on the prescription.
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yes
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See, water is wet.
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thanks for this tips and my goal is to keep myself healthy..
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You're welcome
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Good post, I am a photographer, it passes for my blog and sees my content, I hope that it should be of your taste, you have my vote :D greetings
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Thank you
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Upvoted. I'm going to resteem this now :]
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Very kind of you. Thanks a lot!
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It has a lot of effect on prescription
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Indeed
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This kind of like bribing, I think this should be regulated as this doesn't make it a fair market for all pharmaceutical companies thus decreasing competition and our chance to get better medicine.
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It should not be allowed at all IMO. The conflict of interest is too huge and it does have a potential effect on the sort of care people receive. Our focus should be on providing the best care for patients, giving them a drug if and when they really need it. Bias due to gifts should not be something we tolerate.
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Big-Pharma has got to go. The name of the game is money while good people suffer tremendous damage from these drugs and the whole of society suffers. This was an excellent post.
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I disagree with that. However practices like this should be put to an end.
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So what about the opioid epidemic and all of the horrible side effects from antidepressants, yes many drugs are vital to certain conditions, but there is a huge problem destroying society and doctors and big pharma are directly responsible. Nature has already found better cures but this conflicts with profits
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Pharma isnt prescribing the medications.
Depends on what you are trying to treat. Statements like the one you made there are misleading at best, and generally false. Many pharmaceuticals are natural compounds, or derived from those compounds.
You have to realize I am a pharmaceutical research scientist (at the moment). I am quite critical of pharma's faults and I don't mind pointing them out. However there are many good pharma companies out there, and the drugs that these companies produce in many cases save an awful lot of lives.
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You have to realize I had a family member who died from chemo therapy, another family member who died from incompetent doctors, and another family member who has destroyed her brain from opioids and antidepressants. When you have that many family members suffer from this problem then you will understand this science is flawed.
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Sounds like your problems are with bad physicians. Died from chemo therapy? One does not die from chemo, it's a last ditch attempt to save someone who will die from cancer.
I think your perspective is skewed on this subject and you have lost objectivity.
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Yes off course! Cheating is not the American way. It is small, while we are large. It is cheap, while we are richly endowed. It is destructive, while we are creative. It is doomed to fail, while our gifts and responsibilities call us to achieve. It sabotages trust and weakens the bonds of spirit and humanity, without which we perish.
@justtryme90 gifts 🎁 are life coins with two faces; it can make good and it can corrupt minds.
Thanks.
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Indeed, well said.
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Great read, as a pharmacist that's worked in the medical field for close to a decade, though anecdotal I have seen the effects of these "gifts."
My solution, get the gov't out of healthcare!
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Ironically, I think the very opposite is a better solution. There are insufficient regulations to prevent these sorts of things. Bribery is truly the free market at work :)
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I really used to feel the same, but unfortunately I've noticed two things about gov't interventions in medicine (again this is anecdotal):
Just my 2 satoshis, appreciate the reply!
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This is a protocol worldwide it seems. In the third world countries like the Philippines some doctors prescribe expensive drugs to patients without looking at the financial capability of the patient so long as he prescribed the drugs from certain pharma company who promised him incentive through the med reps.
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Yeah, its an issue that much is for certain. It's something that I think everyone needs to take a long hard look at.
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Corruption American-style can result in trillion-dollar gifts to pharmaceutical companies, the purchase of elections with massive campaign contributions, and tax cuts for millionaires as medical care for the poor is cut.
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I'm not going to get into the politics of it all...
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With bribe from big pharmas, the doctors becoming richer, while the poor parients suffers. Let us go back to alternative medicine.
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I am all for 'alternative medicine' - once it has been proven to be safe and effective in randomized clinical trials
But then that would make it 'medicine'... 😀
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;)
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Congratulations! This post has been upvoted from the communal account, @minnowsupport, by justtryme90 from the Minnow Support Project. It's a witness project run by aggroed, ausbitbank, teamsteem, theprophet0, someguy123, neoxian, followbtcnews/crimsonclad, and netuoso. The goal is to help Steemit grow by supporting Minnows and creating a social network. Please find us in the Peace, Abundance, and Liberty Network (PALnet) Discord Channel. It's a completely public and open space to all members of the Steemit community who voluntarily choose to be there.
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@justtryme90 - I think educating the public/patients is just as important if not more important than educating the doctors. That's like trying to tell the politicians to do a better job when we should be letting the citizens make more informed decisions about who they vote for. Great article and I am really enjoying #steemstem (as a former research scientist turned rogue and working in the IT industry :p) and you do a great job with this channel/topic :)
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