Physicians and Prescriptions

The pharmaceutical industry is an indispensable partner in healthcare today. But the industry, like any other, is profit driven and focused in the bottom line. However, what sets the pharmaceutical industry apart from others, such as he automobile or cement industries, is the fact that it has to depend to a large extent on a third party, namely physicians, to make its sales. The consumer (the patient) hardly ever makes a decision on which brand of antibiotic to choose; it is the doctor who decides on their behalf.

What is that makes a prescribing doctor opt for one particular brand of a drug rather than another? One would assume that would be the patients’ best interest. However, often with little or no difference between competing brands, a little encouragement (euphemistically called “reminders”) from a medical rep can help sway the prescribing hand in the desired direction.

The resources at the disposal of the medical rep to encourage a sale can be impressive. Depending upon the prescribing potential of the doctor concerned, the medical rep can pull out a Varity of “gifts” from the bulging bag that he carries. Physicians with the potential for prescribing or utilizing prostheses and devices can expect greater rewards since the sales they enable have a greater margin of profit for the manufacturer. Form innocuous pens and pads to mugs to mobile phones and taking care of car payment installments, even the sky is not the limit. Fully funded trips abroad with families for” conferences” along with spending money is one of the most popular and effective ways of influencing physicians.

Physicians of course insist that they are not in the least affected by this generally, contrary to numerous studies that have proven that prescribing patterns are significantly influenced by the industry’s marketing ploys. Getting influenced by sales gimmicks (including gifts) is nothing new.

It however becomes problematic in the healthcare setting as the physicians’ prescription enriches he industry and has the potential of benefiting the physician himself, while it is the patients ho end up paying the bills. Whether it is a coffee mug or a trip to Bangkok, it is the patient who pays. The process has become internalized to the gifts from the industry and sometimes demands them as a right. The public is increasingly aware of the alarming influence the industry has come to wield on physicians and their confidence is eroding in what once was a noble profession. Measures need to be taken both by physicians a swell as by the pharmaceutical industry to stem this trend.

(By Dr. Aamir Jafery: The writer is associated with the Centre of Biomedical Ethics and Culture, SIUT)