Thursday, March 6, 2008

A Response to Parable Comments

I have received a couple of good, critical comments to my posting entitled 'A Parable to Ponder'. I encourage you to read that parable and those comments, and then review this response to those comments. It is understandable that my zeal for the cessation of direct-to-physician marketing and gifting by pharmaceutical companies may have come across as an opposition to pharmaceutical companies as a whole. That is not my position and I will explain further, and respond to other comments as you read on...

I was asked to remain open-minded about Pharma and learn more about their role and influence in medicine before jumping to conclusions. You all should know that I firmly believe the pharmaceutical industry has produced amazing medicines and devices that have saved millions of lives and improved the quality of life more millions more, including myself. I would hate to see what this world would look like without the products this industry has put forward. Pharma has created the Partnership for Prescription Assistance to help poorer patients receive medicines in this country. My issue with Pharma lies in their violation of medical ethics. When a company deals in medical products and has a mission statement stating that you want to improve patient's lives as much as possible, they have put themselves under the constraints of medical ethics. Therefore you violate medical ethics and your stated mission by:
-Intentionally trying to influence physician's to prescribe your product more than a competitor by giving them free gifts.
-Saying you are helping educate physicians but providing research data that only SUPPORTS the product, providing data that only compares the product to placebo and not others in the same drug class
-Saying you are giving free samples for distribution to poorer patients but only providing free samples of the newest, most expensive Tier 3 drugs that a poorer patient would never be able to afford.
-Advertising to consumers with coupons for __# of days free of a medicine if your doctor will prescribe it for you.

So many great resources relating to these issues can be found at Different companies participate in these practices to different degrees, but the practices are highly prevalent in every major Pharma company like Wyeth, Pfizer, Amgen, etc.

Physicians are ALSO a part of this medical ethics violation. By accepting free gifts no matter how small, you are creating a conflict of interest. Find the time and take it to do your own research. Don't even risk the appearance of a potential ethical violation. Don't accept the gifts. This is the mission of PharmFree. To help physicians and future physicians see the conflict for what it is, and to change their personal behavior. My personal opinion is that a pharm rep could come to my future office leave their research data and free samples at the front desk and leave. I will not see them. I will review the data as a part of a larger literature review, and I will only give the samples to the patients who will benefit most from that drug AND cannot afford it, but will also educate them on how to get prescription assistance.

Another commentor posted a thought about eliminating all Pharma marketing. I do not think this is feasible. Remember that these companies are operating in a unique business arena where they can only hope to get physicians to write prescriptions. They do not have many options within their federal regulation constraints to get the word out about complex products that they have invested billions of dollars and 7-15 years of research and development in. I believe that direct-to-consumer advertising does get patients to see their doctors more for conditions that need to be treated, while also generating a fair share of hypochondriac syndromes. I also think in a minority of cases these patients put pressure on the doctor to prescribe the medication they heard about. That is pressure doctors should be able to resist through good communication and patient education based on the physician's personal research. Yes Doctors also see the ads on T.V., but in this case they do not have the subconscious drive for reciprocity of the gifts back to the Pharma company. This is a tougher issue because, as I said before, we need Pharma to survive and progress in this world. Ultimately we just need to find a way to get both Pharma and Physicians to interact ethically so that patients get the most possible benefit and Pharma survives economically.

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