Watching the pharmaceutical industry interact with the medical profession today is a little like watching the predatory activities of the Boa Constrictor, the giant Amazonian serpent that coils around its prey, crushing and choking off its airflow, until it lies lifeless, ready for consumption.
In the same way that the Boa Constrictor controls its prey by asphyxiation, the pharmaceutical industry controls the medical profession by coiling firmly around it, doing its utmost to choke off access to all information except that which benefits its own agenda.
In order to further its goal of creating the largest possible marketplace for its products--that is, to have as much of the world's population as possible placed on pharmaceutical drugs--the drug companies spare no expense in shaping the thought patterns and prescribing practices of those who ultimately determine the success of their products--doctors.
You think I'm being overly melodramatic? Well, don't take my word for it.
In an article titled "Physicians' ties with the pharmaceutical industry: a critical element of a wildly successful marketing network", Jerome P. Kassirer, MD, former Editor-in-Chief of the prestigious New England Journal of Medicine, gives numerous examples of the myriad ways that drug companies influence physicians' prescribing behavior.
Kassirer recalls how, during his tenure as Editor-in-Chief at NEJM, it became increasingly difficult to obtain authors who did not have financial ties to the companies whose products were being discussed in submitted articles. In fact, Kassirer's successor found it so difficult to find authors without conflicting financial ties he abandoned the journal's conflict-of-interest policy in 2001!(8)
Many doctors on the receiving end of such drug company 'hospitality' would indignantly object to the suggestion that it influences their prescribing practices in any way.
Such conviction shows a sad detachment from reality.
Drug companies spend billions of dollars each year maintaining an army of highly-trained sales reps whose job is to convince doctors of the value and superiority of their products. They maintain this expensive practice for one simple reason--it works!
An extensive review by Ashley Wazana, M.D. in the Journal of the American Medical Association examined the impact of drug company interactions on physicians' prescription-writing habits. He found that:
"Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice", even when the requested drugs presented little or no therapeutic advantage over currently-used drugs.
Interaction with pharmaceutical representatives increased the preference for new drugs, and the rapidity with which they were prescribed. The prescription of cheaper generic drugs, meanwhile, declined in conjunction with such interaction.
Acceptance of samples, free meals, and funding for travel and lodging to attend "educational symposia" were all associated with increased requests for addition of sponsors' drugs to hospital dispensaries and increased prescribing of these drugs.
" Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs" and also influenced prescription habits in favor of the sponsor's products.
Interestingly, one of the reviewed studies found that while 85% of medical students agreed it was improper for politicians to accept a gift, "only 46% found it improper for themselves to accept a gift of similar value from a pharmaceutical company."(9)
A recent study of physicians in northwest England underscores Wazana's findings. The study found that the number one source of drug information for physicians was the pharmaceutical industry itself!
Physicians were most commonly introduced to new drugs through pharmaceutical sales representatives, and pharmaceutical companies were the greatest influence on their decisions of which drugs to prescribe. Almost three-quarters of the doctors regarded drug company representatives as an efficient way to obtain new drug information! While the doctors claimed to be generally wary of the drug industry's objectives, they tended to believe that its information would be selective but accurate. The physicians believed that they could generally spot misleading information, but only 17% sought out evidence from peer-reviewed journals before making prescribing decisions. According to the researchers, physicians "were largely reactive and opportunistic recipients of new drug information, rarely reporting an active information search."(10)
To make matters worse, much of the drug company propaganda lavished upon doctors appears to have very little basis in reality.
For example, a recent study by independent researchers in Germany found that 94% of the information contained in advertising material and marketing brochures sent out by drug companies to GPs is not supported by available scientific evidence. They found around 15% of the brochures did not contain any citations, while another 22% contained citations of studies that could not be found. Most of the remaining 63% contained information that was connected with the cited research articles but did not reflect their results. Only 6% of the brochures contained statements that were supported by identifiable scientific literature. The researchers found that medical guidelines from scientific societies were misquoted or changed, drug side effects and risks were downplayed, non-supportive study results were suppressed, treatment effects were exaggerated, and beneficial drug effects were drawn from animal studies.(11)
To think that the majority of physicians rely so heavily on the biased and misleading information dispensed by drug companies, instead of analyzing the data from clinical trials first-hand when making prescribing decisions is nothing short of mind-boggling.
You know, the medical profession could learn a hell of a lot from my buddy Joe, who recently bought himself a new car. Joe is a successful small business owner who has never attended college or university, but his motor vehicle purchasing decision nonetheless involved a degree of careful and objective evaluation that most doctors currently would not even come close to emulating.
Before Joe went anywhere near a car showroom, he compiled a preliminary list of cars that appeared to suit his criteria. He then logged on to the internet where he was quickly able to find crash test data for the half dozen or so vehicles on his list. After contemplating the safety data, Joe's scratched all but two cars from his initial selection. Joe then began pulling up road test articles on the remaining two cars. He began performing various Google searches designed to elicit listings about web sites featuring articles or posts from owners who may have had problems with these same vehicles. From his shop window, where Joe could see customers driving into his car park, he noticed that some of his customers were driving the very models he was interested in. After asking these customers what they thought of their cars, some of them even offered to let the amicable business owner take a test drive.
By the time he finally stepped into a car dealership, Joe was anything but a blank slate waiting to be filled with slick sales BS. Joe knew just about every relevant fact about the car he wanted--mechanical specifications, fuel consumption, weekly running costs, available options--and he already knew the exact color and model he was after. All that remained to be determined was who could give him the best price and who could offer the best after sales service. When the dealer who offered the most attractive deal also happened to be highly recommended by a number of his customers, Joe went ahead and signed on the dotted line.
Compare Joe's methodical approach with the gullible customer who has not done his research; who has not asked around; who arrives at the dealership expecting the salesman to help him determine the best car for his needs; who fails to see the carefully orchestrated sales pitch for what it really is. Who do you think is less likely to get sold a lemon--my 'uneducated' buddy Joe, or our truly misinformed car buyer who didn't bother to do his own independent research beforehand?
The more worrying question is: who do you think the large proportion of doctors that place so much trust in drug company spin are most reminiscent of? My friend Joe, or the gullible, uninformed car buyer who is easy prey for the first Slick Willie salesman that tells him everything he wants to hear?
This, my friends, is the pitiful state of modern medicine--a field dominated by practitioners who think that highly-biased, smooth-talking drug company salespeople are a reputable source of health and drug information--information whose accuracy your life may one day depend upon.