Current medical journals and the popular press carry numerous articles about the relationships between the drug manufacturing industry and physicians. Newspapers and computer screens roar with disturbing headlines: “Doctors reap millions for anemia drugs”; “Pills for Patients, Payday for Docs”; “Posing as Pals, Drug Reps Sway Doctors’ Choices.”
The perception of physicians created by these stories raises many questions. It often appears that physicians and pharmaceutical companies are engaged in an unholy alliance where greed and money rule.
Some reports would have you believe most doctors are checking patients with one hand and looking for a handout with the other. It’s true that some physicians (as well as drug company representatives) may lose their ethical compass from time to time. Thankfully, the overwhelming percentage of my profession is populated with good, honest, decent, and caring people.
Even within the profession, bona fide differences of opinion exist about the physician-drug company relationship. Purists believe that no connection at all should exist between drug representatives and doctors; even the acceptance of a pen or pad of paper should be unthinkable. Others think pharmaceutical reps serve a beneficial purpose in the continuing education of doctors about new drugs and therapies.
The physician’s situation is further complicated by the seemingly incessant direct-to-consumer drug advertising, with the tag line being “ask your doctor.” Physicians are often pressured by patients’ demands for the latest drug, even though a time-tested, less expensive medicine may be more appropriate, effective, and assuredly safe based on experience.
The reality is that most physicians will act in the best interests of their patients within the bounds of the many regulations and restrictions put on the profession and in accordance with their own consciences. There’s good reason why physicians must be licensed to practice.
But some perspective is needed on this topic of relationships.
Business ethics and medical ethics are different. What business considers normal, medicine may often consider unethical. In business, it is common to reward and entice to stimulate sales. Medical ethics prompts physicians to consider that if promotional activities were eliminated, the savings could be used to lower the cost of drugs.
However, let’s remember that the medical achievements of the 20th century have been spectacular. Both our personal and public health are at levels of care never before imagined. Vaccines have eliminated diseases such as poliomyelitis and smallpox and now prevent ones like influenza and whooping cough. New developments will protect against shingles and meningitis. Organ transplantation is now common, and lifespan has increased. Advances in technology have allowed us to diagnose and treat diseases earlier and faster, continuing the chances of a better outcome for patients. Millions of lives have been saved, and much suffering has been averted. The drug companies have played a major role in the evolution of this story.
To continue the progress of medical discovery, the pharmaceutical industry and the medical profession must work together in a relationship devoid of self-interest and greed. It should be all about the patient and the betterment of health and relief of suffering for everyone. Indeed, the Pharmaceutical Research and Manufacturers of America in 2001 aligned itself with the American Medical Association in defining acceptable guidelines regarding gifts to physicians.
So where does the patient fit in? With the soaring cost of health care, everyone should become more cost-conscious. This is especially true about medicines because no other product is purchased so blindly.
Patients can begin by taking better care of themselves. To begin, eat a proper diet, get ample exercise, and avoid high-risk behavior. Follow through with periodic medical check-ups and screenings. The healthier we are, the fewer drugs we need. If you do need medicines, confide with your physician in selecting the most appropriate medicine for your condition. Don’t be dazzled by the latest drug advertisement. Often, the tried and true may be the best for you.
I believe the principles I learned in medical school many years ago hold true today: prescribe as few medicines as possible, and when doing so, use medicines that are therapeutically effective, have a wide margin of safety, and cost the least. That approach should work best for both physicians and patients.
Dr. Leonard J. Morse is commissioner of Public Health for the City of Worcester, past member and chair of the Council on Ethical and Judicial Affairs of the American Medical Association, and past president of the Mass. Medical Society.