On the Unethical Relationship Between Doctors and Pharmaceutical Firms

Parvaiz Muzaffar

The basic role of a medical representative is to apprise the doctor about his company’s products including the drugs. There is nothing wrong in that as long as the ultimate beneficiary of this information is the patient. After all, continued professional development is an essential component of a good health care system. There is a conflict between the interests of the patient and those of the doctors as far as the drug promotion is concerned.

A conflict of interest exists when a primary ethical or professional interest clashes with financial self interest, a situation that arises commonly in the medical profession. Promotion strategies adopted by various drug companies are too attractive to be resisted by a doctor. Because of the high competition among drug companies to sell their products much more, they have to increase the sales strategy by attracting physicians through the aggressiveness of medical representatives. They tend to have more frequent interactions to encourage physicians to prescribe drugs and thus increase sales .Such interactions are gift samples industry- paid meals, funding for travel or lodging to attend different programs. This, in turn, places the interest of the doctors ahead that of the patients. Doctors, who are frequently in contact with medical representatives, are more likely to prescribe newer and expensive drugs of their favorite pharmaceutical companies to achieve their selfish ends , that is, to receive more and more financial gain from the companies as cutbacks.

The doctors are held in high esteem by the gullible patients. They are considered second to ‘Gods’ by most patients. Therefore, doctors may prescribe expensive drugs of their favorite pharmaceutical companies with scant regard for the expense borne by the poor patients. Relationships of doctors with drug companies begin when they are just medical students attending the various clinical OPD’s and wards during internship and residency training, and persist throughout their professional careers. The Nature and Effect of the Relationships The drug-companies interact with doctors in order to promote their medical products. They reach out to almost all concerned doctors to attain their goals. The doctors are compensated adequately in the form of gifts and other incentives by drug companies. Consequentially, both the parties are benefited from this interaction with potential consequences for patients. Few doctors may be morally so stout that they continue to prescribe those medicines that appear to be most beneficial as well as economical to their patients despite being in contact with so many drug companies.

The aggressive marketing strategies by the companies just act as tools of information for them. But the prescribing behavior of a vast majority of the medical community is palpably influenced by pharmaceutical companies. Many physicians believe that their interactions with drug companies have educational value for themselves and also provide benefits for patients, because physicians are kept informed about available therapeutic agents and the poor patients can be given free drug samples provided by different companies. Some physicians contend that they themselves are invulnerable to any bias as a result of interaction with drug companies. There is a growing consensus among doctors that prescribing more expensive brands of reputed companies of which the quality is assured is far better than prescribing cheaper brands of unknown quality. This may be one of the reasons behind such shoddy prescriptions. But this cannot be generalized. It is open secret that the professional associations depend solely on pharmaceutical companies to sponsor their medical programmes viz., CME’s, (continuing medical education)Conferences, Annual Meeting, Workshops etc.

Many junior as well as senior physicians seek sponsorships or financial aids from these companies to attend national as well as International Conferences. Even pleasure trips within the country and abroad for a few heavyweight doctors and their immediate family members are arranged and funded by some pharmaceutical companies. The doctors, in turn, tend to reciprocate by prescribing medical products of these companies in blatant disregard to patient’s welfare. There are many different ways by which drug companies relate directly or indirectly with doctors. These range from the seemingly trivial ( the ubiquitous dispensing of gifts such as pens and writing-pads with drug names inscribed) to the much more fascinating gifts( the ghost writing of articles for teaching faculty, the payment of large sums in cash to prominent physicians who extol the virtues of company products and the support of lavish trips and entertainment for physicians who commonly prescribe company products).

As a consequence of the relationship between doctors and drug companies, the credibility of medical profession in the eyes of the patients and the public is ever on the decline. If a patient gets to know that the doctor is prescribing medical advice on the basis of commercial influence he may lose trust and confidence in the doctor (which are the precursors to any successful treatment). In such a scenario, patients are more likely than doctors to believe that gifts may influence prescribing behavior that is morally inappropriate according to them.

— The author holds an M.pharm (pharmacology) from IPS Academy, Indore. He can be reached at: Parvaizmuzaffar@gmail.com