Published August 17, 2016
On Feb. 22, 2016, the White House submitted to the U.S. Congress a $1.9 billion emergency supplemental appropriations request from...
— William Wilberforce
It is no secret that the medical field is heavily influenced by the pharmaceutical industry. For many decades, health care professionals and pharmaceutical companies have enjoyed cozy financial relationships.1 Pharmaceuticals continuously interact with medical doctors (MDs) and Doctors of Osteopathy (DOs), the two types of physicians who are licensed for prescribe drugs in the U.S. in order to persuade them to promote and prescribe drugs and vaccines to patients. Physicians are then compensated in many forms for promoting patient use of pharmaceutical products.
Big Pharma funds medical education programs for physicians and then pitches new drugs to them. Pharma pays doctors for promotional speaking engagements and provides them with free drug samples and free meals, etc.2 To get an idea of the extent of these financial ties, the pharmaceutical industry paid physicians and hospitals at least $3.5 billion during only the last five months of 2013.3
While such ties favor the bottom line financial interests of both parties involved, they have raised serious questions about conflicts of interest in the medical field. At the heart of the conflicts of interest issue is whether physicians heavily influenced by the pharmaceutical industry are able to provide quality care to patients if they are unable to separate the interests of their patients with their own personal relationship with industry.1
Drug companies are known for employing aggressive marketing strategies and the pharmaceutical industry is deeply rooted in the medical system. Some scholars map the pharmaceutical stronghold on physician attitudes and behavior to medical school…
Interaction between drug companies and doctors are pervasive. Relationships of doctors with drug companies begin when they are just medical students attending the various clinical OPD’s and wards, continue during internship and residency training, and persist throughout their professional careers.1
Over the years, the credibility of the medical profession from the patient’s perspective has continued to decline because of the relationship between physicians and industry.1 It is now being realized that relationships between doctors and the pharmaceutical industry are a central public health issue that must regulated and contained within reasonable boundaries.1 A growing number of critics are pointing out the danger of the too-cozy relationship between doctors and drug companies and are beginning to push for more transparency around these murky relationships.
As part of the 2010 Affordable Care Act, the Physician Payment Sunshine Act, led by Senator Chuck Grassley (R-Iowa) and Senator Herb Kohl (D-Wisconsin), called for the first public release of all drug and device company payments to physicians.4 5 The law mandates that all manufacturers of drugs, medical devices and medical supplies who have at least one product covered by Medicare or Medicaid disclose payments and gifts they have made to physicians and teaching hospitals.6
As a result, in 2014, the Centers for Medicare & Medicaid Services launched a new website, Open Payments, which is a tool naming all doctors and teaching hospitals that received funds and gifts from drug companies.2 Since this database is in its early stages of development, users are advised to analyze the data with caution.3 4
In addition to promoting overall transparency, the aim of publically releasing these drug company payments is to provide patients with the ability to assess where their physician’s bias and financial interests may potentially lie.5 The data available through Open Payments raises legitimate concerns about whether some physicians are too closely tied to drug companies and are biased toward certain manufacturers when writing prescriptions and promoting use of pharmaceutical products to patients. According to ThinkProgress:
That data set begins to reveal a piece of what’s become a lucrative industry. Pharmaceutical companies spend nearly $20 billion annually marketing their products to physicians, efforts that yields profits of nearly $300 billion per year in prescription drug sales. At the peak of Big Pharma’s profitable relationship with the medical industry in 2007, more than 100,000 representatives made visits to more than 650,000 physicians across the country.7
Some critics of the Open Payments database are questioning if conflicts of interest questions are solely driven by moral outrage.2 Some argue that although, in theory, physicians and drug companies should essentially be striving for similar goals, their underlying financial relationship is always going to be perceived as suspicious, and that could have a negative impact on development of life-saving therapies.2
According to Vox, cardiologist Lisa Rosenbaum’s piece in the New England Journal of Medicine argues…
that the stigma against doctor-industry collaboration could have all sorts of negative effects. It might mean that effective drugs get to market more slowly. It might mean that experts with important views get ignored or silenced because they happen to work with drug companies. It might mean that, ‘life-saving therapies whose development requires the combined talents of clinicians and industry scientists don’t materialize.’8 2
Rosenbaum goes on to further express that…
I’m not suggesting abandoning regulation. When the rules work, they protect us and our patients from fraudulent marketing and twisting of facts. But when rules merely cloak an anti-industry bias in the false promise of scientific virtue, we undermine potentially productive research collaborations, dissemination of expertise, and public trust.8
On the flip side, critics of the close financial relationship between physicians and drug companies have argued that clear evidence exists to demonstrate that ties between physicians and Big Pharma breed dangerous circumstances and jeopardizes quality medical care. In response to Rosenbaum’s argument questioning conflict of interest policies, three doctors—Robert Stenbrook, Jerome Kassirer and Marcia Angell wrote a rebuttal in the British Medical Journal stating:
Physicians and the public rely on journals as unbiased and independent sources of information and to provide leadership to improve trust in medicine and the medical literature. Yet financial conflicts of interest have repeatedly eroded the credibility of both the medical profession and journals. As the Institute of Medicine explained in its 2009 report, a conflict of interest is ‘a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.’10 The key issue is that ‘a conflict of interest exists whether or not a particular individual or institution is actually influenced by the secondary interest.’10 9
Given the complicated nature of the relationship between physicians and drug companies, coupled with the push for medical innovation, there are legitimate conflict of interest issues that need to be addressed by the medical community, including: Where should the line be drawn between industry and physicians in order to protect the patient?
1 Bansal RK, Das S. Unethical Relationship Between Doctors and Drug Companies. Journal of Indian Academy of Forensic Medicine 2005; 27(1).
2 Belluz J. The Surprising Debate Whether Doctors Should Have Ties to Big Pharma Vox Science & Health June 4, 2015.
3 Belluz J. Doctors and Hospitals Got At Least $3.5 Billion From Industry in the Last Five Months Vox Healthcare Sept. 30, 2014.
4 Ornstein C. What to be Wary of in the Government’s New Site Detailing Industry Money to Doctors. ProPublica.org Sept. 30, 2014.
5 Young J. Big Pharma’s Money Ties To Doctors Revealed. Kind Of. The Huffington Post Sept. 30, 2014.
6 Thomas K, Armendariz A, Cohen S. Detailing Financial Links of Doctors and Drug Makers. The New York Times Sept. 30, 2014.
7 Collins S. You Can Now Find Out How Much Big Pharma is Paying Your Doctor. ThinkProgess Oct. 1, 2014.
8 Rosenbaum L. Beyond Moral Outrage–Weighing the Trade-Offs of COI Regulation New England Journal of Medicine 2015; 372(21): 2064-68.
9 Steinbrook R, Kassirer J, Angell M. Justifying Conflicts of Interests in Medical Journals. The British Medical Journal 2015; 350.
10 Lo B, Fields M. Conflict of Interest in Medical Research, Education and Practice. Washington D.C. The National Academies Press 2009.