We all want to trust our doctors and, at the end of the day, we sort of have to. We like to think that being bound by the Hippocratic Oath means that they will always have our best interests at heart. But is that really true? The way that doctors treat patients has changed drastically over the past decade or two. This is not only because of advancements in the field, but also because of the more traditional approaches they take. Doctors recommend prescription medications far more often than natural, home remedies. Seventy percent of Americans are currently on at least one prescription medication, and fifty percent are on more than one. That adds up to over 4 billion prescriptions annually. Of course everyone that needs medication should have access to it, but that sounds like quite a lot.
This proliferation of prescription medications is costing Americans a lot. In 2013, Americans spent $329.2 billion on prescriptions—about one thousand dollars per person. This sounds crazy, but begins to make more sense when considered in the context of the number of ads and commercials dedicated to marketing these drugs to the public—three billion dollars’ worth in 2012. Pharmaceutical companies also need to target doctors directly to get them to recommend the drug to their patients. An estimated twenty-four billion dollars was spent in 2012 marketing these drugs directly to doctors. In 2014, the BBC reported the highly concerning fact that nine out of ten pharmaceutical companies spent more on marketing than they did on research.
Another issue of concern is the conflict of interest posed by the doctor-sales representative relationship. Sales reps, who often do not have a medical background, offer a lot of free perks to medical offices, including free lunches, in the hopes that the doctors will prescribe their product. Every time a pharmacy fills a prescription, pharmaceutical companies can track which doctors prescribed their product and which prescribed a competitor’s. If a doctor is frequently prescribing a competing drug, often a
sales rep that has a relationship with that doctor will pressure him to prescribe his company’s product instead.
Even more pressing than the issue of prescribing one brand of drugs over another is the issue of over-prescription. There are many recorded cases of doctors “going off label,” or prescribing FDA-approved drugs for unapproved uses. For example, antidepressants are sometimes recommended to help with weight loss. This is potentially very dangerous for patients and can create a chemical imbalance. However, it is very profitable for drug companies.
Pharmaceutical companies also often hire doctors as “thought leaders” to promote their products to other doctors. This often takes place in an informal setting, such as a one-on-one conversation or in a conference room, when the audience may be unaware that the doctor is being compensated for his endorsement and is being told exactly what to say and how to say it.
These points are all very concerning because we rely on our doctors a lot and want to trust them. Thankfully, we can take some comfort in the fact that new reforms are being made to prevent doctors from putting their own interests before that of their patients. In addition, a new federal website called OpenPaymentsData.CMS.gov has been created that lists every doctor legally practicing in the United States and what he or she is getting from each pharmaceutical company. Many doctors have been paid for research they have done for drug companies, which is totally above board. But there are some doctors who have been paid close to a million dollars for delivering talks and consulting. There are doctors of every sort out there, so be sure that yours is one you can trust.