jueves, 12 de septiembre de 2019

US: Pharma companies, reps & physicians relationships

ABSTRACT: Pharmaceutical companies and many physicians in the United States have close relationships which are increasingly well documented. These companies are a source of lavish treatment, questionable information on new drugs, and varying types of financial support for doctors. It is not at all clear, however, if and how this affects the health of patients. 
Here we explore the nature of these relationships and question their impact on health inequalities.



According to official US government figures, physicians in the United States received a total of $8.18 billion from pharmaceutical companies in 2016 (U.S. Centers for Medicare & Medicaid Services, 2017). 
The payments were categorized as

  • “General Payments”, 
  • “Research Payments” and 
  • “Ownership and Investment”. 

The CMS further sub -defines the nature of payments on its website (U.S. Centers for Medicare & Medicaid Services, 2017) with categories, among others, including payments for consultation, royalties or licensing and education, but also gifts, entertainment and food.

The CMS website reported that around 631,000 physicians took payments from 1,481 companies in 2016

This indicates roughly 2/3rds of US doctors have some sort of financial connection with pharmaceutical companies, given there are around 950,000 registered practicing physicians in the US (Young, Chaudhry, & Pei, 2017).


Given the evidence presented, that pharmaceuticals have a clear incentive in influencing doctors'prescribing behaviors is undeniable. Based on the numbers spent on marketing to doctors by pharmaceuticals and the opinions of doctors themselves, it has been concluded that pharmaceuticals are highly successful in dictating doctors' prescribing behavior. This then assumes that patients in the US who see doctors that are targeted by pharmaceuticals are at a higher risk of being prescribed inappropriate or more expensive drugs, or doctors over-prescribing.

What is needed, however, is research into exactly how these disparities in physician prescribing behavior impacts health related inequalities for patients. Such research should focus on 2 key aspects: health outcomes and cost. Data on which doctors have relationships with pharmaceutical companies are readily available, data which include the nature and extent of the relationships. What must be ascertained is whether patients of these doctors are receiving comparable care to those whose doctors aren’t affiliated, and whether they are liable to pay more for their medication.

As always, the most impactful reforms in society take place when individuals educate themselves and share the responsibility to make change. This creates a large demand for research and reporting. Small-n, qualitative research is impactful in exposing the nature of such alarming relationships more in-depth and within small communities that US citizens can relate to. 
Finally, research must be as recent and localized as possible to increase the relevancy of the impact doctor-pharmaceutical relations have on customers. Since legislation differs by state and pharmaceutical companies have differing amounts of influence in each state, research should measure and analyze these relationships on a state level. 
Continuing research then must address the question: how can doctors be spared from the influence of pharmaceutical power and what role does society have in holding their doctors accountable to good practice?


Ultimately, doctors will be more likely to focus on their relationship with patients rather than with the pharmaceuticals. 
Some change is already taking place as doctors have begun to sign the "No Free Lunch" pledge, which creates an online directory of doctors who have taken the pledge to "accept no money in order to assert their transparency and dedication to ethical health care practices to patients”. 
Patients can access a directory which shows a list of doctors in their area who have pledged, "to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my practice, teaching, and/or research" (No Free Lunch, 2017) (Mas)

Ver también: 
"No Free Lunch" is merging with Healthy Skepticism
AI Médicos progresistas & "No Gracias"

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