In the early 1990s, pharmaceutical companies promoted
opiates as the clear solution to addressing chronic pain. Their marketing
campaigns deliberately ignored the addictive nature of these drugs in an effort
to win over societal influence, most notably through physicians across the
country. Interactions between physicians and the pharmaceutical industry are
vital to understanding the origins and pronounced effects of America’s opioid
crisis. The complex relationship between individuals and industry sets a
standard which has direct implications on prescription patterns and the imminent
danger we face as a nation. As a
whole, dealings on multiple levels form a possible basis for studying the cause
and effect status of the American opioid crisis.

            The
issue of responsibility is at the core of the physician-pharmaceutical
relationship. To develop a clear idea of the relationship dynamic, the origins
of pharmaceutical influence must be investigated. In the mid-1990s, after fraudulent
studies falsely verified the safety of OxyContin, Purdue Pharma strongly
marketed the newly developed opioid treatment. From 1996-2001, sales grew from $44
million to $3 billion and prescriptions skyrocketed from 316,000 to nearly 14
million (Poitras, 2012). This drastic increase was driven, in part, due to the
widespread expansion and efforts of pharmaceutical sales representatives, who
act as connections between large companies and physicians. These individuals
attempt to persuade doctors to prescribe specific company drugs. From
1996-2000, Purdue Pharma increased its number of sales representatives from 318
to 671 and doubled the number of physicians who were frequently visited by
these representatives (Van Zee, 2009). Routine visits gave pharmaceutical
companies the opportunity to treat doctors to lunches, offer drug coupons for physicians
to distribute to patients, and to identify physicians with high opioid
prescription rates (Brett, Burr, and Moloo, 2003). These exchanges cemented the
budding influence of pharmaceutical companies across the nation.

A rewarding bonus system also
motivated sales representatives to increase opioid prescriptions in certain areas
(Van Zee, 2009). This formed a vicious cycle which targeted physicians who had
abnormally high rates of opioid prescriptions. Today, it is estimated that one
in five family practice physicians accept payment from pharmaceutical companies,
with the top one percent of doctors averaging $2,600 in yearly payments (Boston
Medical Center, 2017). It is clear that the pharmaceutical industry has built a
close relationship with physicians. Despite this evidence, the question remains:
Does this frequent interaction actually affect physicians’ prescription habits?

            The
answer to that question is an obvious and resounding: yes. Physicians are not
only the recipients of substantial monetary gain, but are also treated to all-expense
paid pharmaceutical conferences and respected for their ability to act as
opinion leaders within their field (Poitras, 2012). Through these interactions,
along with those of sales representatives, causation can be readily observed.

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In a review of several journal articles, Wazana found that most interactions acted
as source of persuasion: physicians were unable to identify inaccurate claims
about medications, positive attitudes towards sales representatives led to
preference towards marketed drugs, and irrational and increased rates of
prescription could be observed following visits (2000). Although a majority of
physicians claim that the perks they receive have little effect on their
prescribing habits (Orlowski and Wateska, 1992), there is an abundance of
evidence to the contrary. It is highly unlikely that pharmaceutical companies
would spend an exorbitant amount of money to market drugs to physicians if
these techniques were unproductive.

Furthermore, the pharmaceutical
industry takes on a large role within medical education. From 1996-2002, Purdue
Pharma funded 20,000 pain treatment educational programs, providing the
industry with a further occasion to influence physicians (Prescription Drugs, 2003). These programs were not taught by
reliable experts but were rather overseen by those who had ties to large drug
companies. The role of industry within education presents a risk, especially
with an addictive class of drugs such as opiates. The opportunity to overlap
marketing and education is omnipresent and detrimental to public health as a
whole. Overall, these studies raise serious questions about conflict of
interest and the overall ethics of the physician-pharmaceutical relationship.

            While
it can be hard to understand why physicians are so easily swayed, the context
of their profession must be taken into consideration. At the core of a
physician’s responsibility is addressing pain. If they are led to genuinely
believe that opioid medications are effective and safe, it is no wonder that
they turn to them in an effort to alleviate their patients’ pain. However, with
the addictive nature of opioids becoming harrowingly clear, physicians must be
more conscious in their prescription habits and in their interactions with
sales representatives. Doctors owe their patients an assured safety. At this
moment in time, a relationship with pharmaceuticals is obscuring that promise and
raising concerns over individual gain versus social responsibility.

            The
ethics of the physician-pharmaceutical relationship is a dilemma at the core of
our nation’s opioid crisis. Leaders on both sides of this complicated
association must realize the consequences of their actions, whether they be
intentional or not. It is clear that the pharmaceutical industry actively exerts
their influence through physicians. Current marketing practices are not safe to
patients, are devious to physicians, and are intended to earn the most profit
for those associated with industry. It is high time that change be made to
better define the ways in which these two sectors of public health relate to
one another.

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