There is so much left unsaid in today’s The New York Times article – Glaxo Says it Will Stop Paying Doctors to Promote Drugs. First of all, were you even aware that Glaxo (and other pharma companies) pays “tens of millions” of dollars every year to have doctors promote their drugs at conferences? Or that Glaxo sales reps are rewarded according to prescription volume? In other words, the more a doctor prescribes a drug (to you, the patient), the more money the rep makes.
About 15 years ago, I was sent to a small Caribbean island with a handful of doctors and their spouses, for a week of “Continuing Medical Education” paid for and sponsored by a large pharma company. I was the medical writer, invited along in case any last-minute research was required. All expenses were paid, the accommodations were lavish, and the wink-wink-nudge-nudge deal was that the doctors would listen to an hour-long PowerPoint presentation each morning over breakfast, before they continued their hazy, lazy days playing in the ocean and being tourists. The never-spoken promise was that these same doctors would then use their considerable influence to prescribe the company’s drug and/or promote it to their peers. They call these head honchos “Key Opinion Leaders” or KOLs, and they figured prominently in the pharma company’s marketing efforts. Whether they were being paid to give their own opinions as physicians or to be spokespeople for a company’s drugs, KOLs made a lot of money off pharma companies “back in the day.”
Part of the Obamacare promise in the USA is to ensure transparency around these processes. Glaxo is getting headlines by being the “first” to voluntarily (ahem) stop the practice among its own ranks. It’s a good public relations strategy, and the average reader will feel all warm and fuzzy about Glaxo for taking this important step towards being good corporate citizens. Here in Canada, Glaxo is a proud provider of dental products (Aquafresh, Poli-Grip ®and Polident®), dozens of prescription drugs (Avandia for diabetes, Ventolin and Flonase for asthma, to name a few) and over a dozen vaccines, for which they are a global leader.
The conflict of interest when money is paid according to prescription volume should be obvious to even the least jaded among us – if there is a monetary bonus for more prescriptions (whether it’s in the form of a sales bonus or a free all-expenses-paid trip) then the decision to prescribe will not be based solely on patient need. The drug Lipitor proved this, when sales of the cholesterol-lowering drug went through the roof and it was revealed that doctors were prescribing it to patients for life, instead of encouraging diet and lifestyle changes first to reduce cholesterol levels. The drug is easier, faster, and (with incentives) more lucrative than doing the hard work. Why would patients complain? Why would doctors resist? Just last week, my mother’s doctor gave me the perfect quote. “There are no side effects,” he said, “And it’s too late for your mother, at age 78, to change her ways.”
Some of the side effects of long-term use of cholesterol-lowering drugs are memory loss and digestive problems, both of which my mother is experiencing. For some reason, though, her doctor refuses to acknowledge any connection between these problems and the drug he continues to prescribe. “She’s old,” he told me, when I asked about her mild dementia. That’s prejudice, pure and simple, and a sign that even our doctors are buying into the inevitability of mental decline.
There’s a chapter in my book about the pharmaceutical industry’s influence on us as consumers. I’ve learned a lot over the years. But whether or not you want to read the book, my advice to everyone is the same. Do your own research, and question your physician if you have doubts. Be a mindful patient, not a mindless one. It’s a nice thing to hope for, but not everyone has your best interests at heart.