In the early 1990s, pharmaceutical companies promotedopiates as the clear solution to addressing chronic pain. Their marketingcampaigns deliberately ignored the addictive nature of these drugs in an effortto win over societal influence, most notably through physicians across thecountry. Interactions between physicians and the pharmaceutical industry arevital to understanding the origins and pronounced effects of America’s opioidcrisis.
The complex relationship between individuals and industry sets astandard which has direct implications on prescription patterns and the imminentdanger we face as a nation. As awhole, dealings on multiple levels form a possible basis for studying the causeand effect status of the American opioid crisis. Theissue of responsibility is at the core of the physician-pharmaceuticalrelationship. To develop a clear idea of the relationship dynamic, the originsof pharmaceutical influence must be investigated. In the mid-1990s, after fraudulentstudies falsely verified the safety of OxyContin, Purdue Pharma stronglymarketed the newly developed opioid treatment.
From 1996-2001, sales grew from $44million to $3 billion and prescriptions skyrocketed from 316,000 to nearly 14million (Poitras, 2012). This drastic increase was driven, in part, due to thewidespread expansion and efforts of pharmaceutical sales representatives, whoact as connections between large companies and physicians. These individualsattempt to persuade doctors to prescribe specific company drugs. From1996-2000, Purdue Pharma increased its number of sales representatives from 318to 671 and doubled the number of physicians who were frequently visited bythese representatives (Van Zee, 2009). Routine visits gave pharmaceuticalcompanies the opportunity to treat doctors to lunches, offer drug coupons for physiciansto distribute to patients, and to identify physicians with high opioidprescription rates (Brett, Burr, and Moloo, 2003). These exchanges cemented thebudding influence of pharmaceutical companies across the nation.
A rewarding bonus system alsomotivated sales representatives to increase opioid prescriptions in certain areas(Van Zee, 2009). This formed a vicious cycle which targeted physicians who hadabnormally high rates of opioid prescriptions. Today, it is estimated that onein five family practice physicians accept payment from pharmaceutical companies,with the top one percent of doctors averaging $2,600 in yearly payments (BostonMedical Center, 2017). It is clear that the pharmaceutical industry has built aclose relationship with physicians. Despite this evidence, the question remains:Does this frequent interaction actually affect physicians’ prescription habits? Theanswer to that question is an obvious and resounding: yes. Physicians are notonly the recipients of substantial monetary gain, but are also treated to all-expensepaid pharmaceutical conferences and respected for their ability to act asopinion leaders within their field (Poitras, 2012). Through these interactions,along with those of sales representatives, causation can be readily observed.
In a review of several journal articles, Wazana found that most interactions actedas source of persuasion: physicians were unable to identify inaccurate claimsabout medications, positive attitudes towards sales representatives led topreference towards marketed drugs, and irrational and increased rates ofprescription could be observed following visits (2000). Although a majority ofphysicians claim that the perks they receive have little effect on theirprescribing habits (Orlowski and Wateska, 1992), there is an abundance ofevidence to the contrary. It is highly unlikely that pharmaceutical companieswould spend an exorbitant amount of money to market drugs to physicians ifthese techniques were unproductive.Furthermore, the pharmaceuticalindustry takes on a large role within medical education. From 1996-2002, PurduePharma funded 20,000 pain treatment educational programs, providing theindustry with a further occasion to influence physicians (Prescription Drugs, 2003). These programs were not taught byreliable experts but were rather overseen by those who had ties to large drugcompanies.
The role of industry within education presents a risk, especiallywith an addictive class of drugs such as opiates. The opportunity to overlapmarketing and education is omnipresent and detrimental to public health as awhole. Overall, these studies raise serious questions about conflict ofinterest and the overall ethics of the physician-pharmaceutical relationship. Whileit can be hard to understand why physicians are so easily swayed, the contextof their profession must be taken into consideration. At the core of aphysician’s responsibility is addressing pain. If they are led to genuinelybelieve that opioid medications are effective and safe, it is no wonder thatthey turn to them in an effort to alleviate their patients’ pain. However, withthe addictive nature of opioids becoming harrowingly clear, physicians must bemore conscious in their prescription habits and in their interactions withsales representatives. Doctors owe their patients an assured safety.
At thismoment in time, a relationship with pharmaceuticals is obscuring that promise andraising concerns over individual gain versus social responsibility. Theethics of the physician-pharmaceutical relationship is a dilemma at the core ofour nation’s opioid crisis. Leaders on both sides of this complicatedassociation must realize the consequences of their actions, whether they beintentional or not. It is clear that the pharmaceutical industry actively exertstheir influence through physicians. Current marketing practices are not safe topatients, are devious to physicians, and are intended to earn the most profitfor those associated with industry. It is high time that change be made tobetter define the ways in which these two sectors of public health relate toone another.