Dr And Pharmaceuticals

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DOCTOR AND PHARMACEUTICALS OBJECTIVES: 1. to define the roles of physicians and pharmaceutical companies in medical care a. Research and drug development b. Marketing 2. to identify issues of concern in the relationships between physician and the pharmaceutical industry 3. to propose ways by which physicians (and pharmaceutical companies) may act ethically in the interest of patients Scientists are the producers Pharmaceutical companies distributors. Patient is the consumer. Physician can be all three.

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Forms of Entanglement • Face to face visits from drug company representatives – food, flattery, friendships, ads (“drug information”) and gift trinkets • Acceptance of direct gifts of equipment, travel, or accommodation • Acceptance of indirect gifts, through sponsorship of software or travel • Attendance at sponsored educational events, continuing medical education, workshops or seminars • Attendance at sponsored scientific conferences • A medical journals’ reliance on drug company advertising, company purchased reprints, and sponsored supplements • Ownership of stock or equity holdings • Conducting sponsored research • Company funding for medical schools, academic chairs, or lecture halls • Membership of sponsored professional societies and associations • Advising a sponsored disease foundation or patient’s group; illness promotion •

Involvement with or use of sponsored clinical guidelines

Undertaking paid consultancy work for companies • Membership of company advisory boards of “though leaders” or “speakers’ bureau” • Authoring “ghostwritten” scientific articles Research • An estimated 60% of biomedical RnD in the US is now privately funded • 2/3 of academic institutions have equity ties with outside sponsors • Finding senior medical researches or clinicians without financial ties to pharmaceutical companies has become exceedingly difficult • Those regarded as “though leaders” routinely work as paid members of drug companies advisory boards • Concern that the evidence base of healthcare is being distorted fundamentally: • A. Evidence shows that industry sponsored research tends to draw conclusions favorable to industry • “systemic bias” in results is not that sponsored science is bad science but rather that the scientific questions being asked reflect the self-interest of the sponsor Information • most physicians felt academic sources to be important; few felt commercial sources to be an important source of information • nevertheless many held views consistent with the commercial, rather than the academic literature The Gap between Science and Practice 1. Technologic Lag 2. access to information 3. patient demands 4. patient needs 5. sciences is questionable physician’s self interest So what’s wrong with receiving gifts? • gifts cost money, and these costs are passed on to patients • physician’s acceptance of gifts contribute to the erosion of the image

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of the medical profession as acting in other than the patient’s best interest acceptance of gifts establishes a relationship between giver and receiver, it creates a strong need for reciprocation on the part of the recipient from which arises conflicts of interest culture of gift giving, which starts with medical students, breeds a long term sense of entitlement = “so it’s a not a bribe; it’s their due” the flipside of the this sense of entitlement is indebtedness, to be repaid by support of the patron’s drugs, a sense of obligation in direct conflict with doctors’ primary obligation to their patients entitlement –may karapatan indebtedness – utang na loob

What is wrong with these Pictures? Case1: Dr. P. is choosing between two drugs from Mr. A. Brand X and Y are equally effective for Mr. A’s condition but Brand Y is more expensive. After seeing the medical representatives for Brand Y who gave out product information about the superiority of Brand Y over X. Dr. P. decided to prescribed Brand Y to Mr. A Ethical Issue: Information and Economics Case2: Dr. Q has been prescribing a new brand antibiotic X to most of his patients this week. A close associate Dr. S made a comment that this is due to the free dinner given last week by the company making antibiotic X. Dr. Q reported that all of his prescriptions were indicated and those promotions do not affect other prescribing habits. Ethical Issue: Self-assessment – naiveté or denial Case 3: Dr T plays badminton with Medreps and executives from company Z. he considers them his friends. When he was in training this company funded his salary. In order to help them with their quota, he prescribes only the brands from company Z and feels a pang of gilt whenever he prescribes other brands. Ethical Issue: Indebtedness

Case 4: Dr. R. has been texting and calling Med Reps all week. He wants to go to Palawan for the mid year Subspecialty conference and expects one of the companies to fund him and his wife for the trip. He also expects them to pay for his registration fee and RnR after. If a company turns him down he will ban them for his hospital’s pharmacy: Ethical issue: entitlement Case 5: Dr. B is a well-known speaker and researcher. He has written a few papers on Drug M and speaks on its merits all over the world. Dr. B is a consultant for company Z, the makers of Drug M. he receives a regular stipend form this company and they also fund his researches Ethical issues: Conflict of Interest Case 6: Drs. A and B are getting paid for “post-marketing surveillance” from company L on Drug XDE. Patients who come in for a certain condition are prescribed the drug by these 2 physicians and response is monitored.