Professional Documents
Culture Documents
Ethical Issues in The Relation of Physicians With The Pharmaceutical Industry
Ethical Issues in The Relation of Physicians With The Pharmaceutical Industry
Year
2013
Company
Johnson & Johnson
[6]
Settlemen
t
Violation(s)
Off-label
$2.2 billion promotion/
kickbacks
Product(s)
Laws
violated
Risperdal/
Invega/
Nesiritide
False Claims
Act/FDCA
Abbott Laboratori
es
$1.5 billion
Off-label
promotion
Depakote
False Claims
Act/FDCA
Amgen[10]
$762
million
Off-label
promotion/kic
kbacks
Aranesp
False Claims
Act/FDCA
2010
GlaxoSmithKline[11]
$750
million
Poor
manufacturin
g practices
Kytril/Bactroban
/
Paxil CR/
Avandamet
False Claims
Act/FDCA
2010
Allergan[15]
$600
million
Off-label
promotion
Botox
False Claims
Act/FDCA
2012
[7]
2012
Source: https://en.wikipedia.org/wiki/List_of_largest_pharmaceutical_settlements
DRUG PROMOTION
DOCTORS = MEDICAL SALES
REPRESENTATIVE
WHO PAYS?
PATIENTS
PHARMACEUTICAL INDUSTRY
SPENDING ON MARKETING
THE GLOBAL PHARMACEUTICALS
MARKET IS WORTH US$300 BILLION A
YEAR, . COMPANIES CURRENTLY SPEND
ONE-THIRD OF ALL SALES REVENUE ON
MARKETING THEIR PRODUCTS ROUGHLY TWICE WHAT THEY SPEND ON
RESEARCH AND DEVELOPMENT.
Source: http://www.who.int/trade/glossary/story073/en/
FIDUCIARY CHARACTERISTIC
OF PHYSICIAN-PATIENT
ARELATIONSHIP
FIDUCIARY IS ONE WHO:
HOLDS
EFFECT OF GIFTS ON
RESIDENTS
EFFECT OF GIFTS ON
RESIDENTS
WHAT
PERCENTAGE OF RESIDENTS SURVEYED ACKNOWLEDGE
THAT GIFTS AND MEALS INFLUENCED THEIR PRESCRIBING
PATTERNS?
91% of residents surveyed acknowledged
that gifts and meals influenced their
prescribing patterns.
As gifts influence prescribing patterns, they
decrease objectivity and increase the
possibility of prescribing based on decisions
other than the best interests of the patient.
PATIENTS ATTITUDES ON
GIFTS TO MDS
Sample: 486 Patients
Type of Gift
Percent
Awareness
Not alright
Free drug
sample
87
7.6
Ballpens
55.3
17.5
Medical books
34.6
16.9
Infant formula
28.6
44.2
Dinner at a
restaurant
22.4
48.4
Coffee maker
13.8
40.7
Blake RL Jr, Early EK. Patients' attitudes about gifts to physicians from pharmaceutical companies.
J Am Board Fam Pract. 1995 Nov-Dec;8(6):457-64.
PATIENTS ATTITUDES ON
GIFTS TO MDS
32.5%
PATIENTS ATTITUDES ON
GIFTS TO MDS
CONCLUSION
APPROVAL RATES WERE HIGH FOR GIFTS
CONSIDERED TO BE TRIVIAL OR THAT HAVE
POTENTIAL VALUE TO PATIENT CARE;
DISAPPROVAL RATES WERE RELATIVELY HIGH
FOR GIFTS THAT HAVE SOME MONETARY VALUE
BUT HAVE LITTLE OR NO BENEFIT TO PATIENTS.
OPINIONS ABOUT GIFTS WERE RELATED TO
PERCEPTION OF EFFECTS ON PRESCRIBING
BEHAVIOR AND COSTS.
REQUEST OF PHYSICIANS
FOR ADDING THE DRUGS TO THE
HOSPITAL FORMULARY
CHANGES IN PRESCRIBING PRACTICES
DRUG COMPANY SPONSORED CME
HIGHLIGHTED THE SPONSORS DRUGS
Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000 Jan 19;283(3):373-80.
CONFLICT-OF-INTEREST
A PERSON IS IN A CONFLICT OF INTEREST
SITUATION IF S/HE IS IN A RELATIONSHIP
WITH ANOTHER IN WHICH S/HE HAS A MORAL
OBLIGATION TO EXERCISE HIS/HER JUDGMENT
IN THAT OTHERS SERVICE, AND AT THE SAME
TIME, S/HE HAS AN INTEREST TENDING TO
INTERFERE WITH THE PROPER EXERCISE OF
JUDGMENT IN THAT RELATIONSHIP.
DAVIS, 1982
GIFT ECONOMY
COFFEE
MUGS, FREE
LUNCHES
PEN LIGHTS
KNAP SACKS
STETHOSCOPES
POCKET TEXTBOOKS
CODES
References
American Medical Association Modules on What You Should Know About Gifts to
Physicians from Industry
Blake RL Jr, Early EK. Patients' attitudes about gifts to physicians from pharmaceutical
companies. J Am Board Fam Pract. 1995 Nov-Dec;8(6):457-64.
Quan SF. , Do You Have A Minute? The Dilemma Posed by Physician Interaction with the
Pharmaceutical Industry J Clin Sleep Med. 2007 June 15; 3(4): 345346
Rodwin MA. Medicine, Money & Morals: Physicians Conflicts of Interests. Oxford
University Press, 1993
Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA.
2000 Jan 19;283(3):373-80.