Healthy Skepticism Library item: 5863

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Haikerwal M.
Doctors have patient's interests at heart
The Age (Melbourne) 2006 Aug 11
http://www.theage.com.au/news/opinion/doctors-have-patients-interests-at-heart/2006/08/10/1154803025195.html

Notes:

Ralph Faggotter’s Comments:

After agggressively defending the indefensible for a couple of weeks, the AMA president has gone into a more cunning soft-sell mode, but he is still singing to the tune of the pharmaceutical marketing industry.

“ AMID the debate about the relationship between pharmaceutical companies
and doctors, one vital issue is being overlooked: what’s best for the
patient.”

Wrong Doctor Haikerwal: it is percisely because of a focused concern for the welfare fo the patient that this issue is receiving so much publicity.

“ The medical profession is aware that the marketing strategies of the
pharmaceutical industry have the potential to influence doctors’
prescribing behaviour, but doctors generally manage this influence well
and prescribe the medication, if needed, that is in the best interests
of the patient.”

Wrong Dr Haikerwal: most doctors are in denial that the gifts they accept from the pharmaceutical marketing industry influence them, even though there is plenty of evidence to show that the marketing practices do work.

“Doctors know that pharmaceutical company promotional material focuses on
the positives of their products but we are uniquely qualified to make
educated inquiries about the claimed benefits, and we are discerning
about the medications we prescribe.”

Wrong Dr Haikerwal: there is evidence to show that doctors are often influenced to prescribe inappropriately by clever drug marketing.

“ At the moment, most drug education for a particular drug is provided by
the company that manufactures that drug. Therein lies the problem. The
drug companies are well placed to provide the medical education for
their products, but when is the line crossed from pure education to
prescribing influence or inducement?”

Wrong Dr Haikerwal: The drug companies are the worst possible source of unbiased information about drugs. Every drug company presentation is an overt or covert sales pitch- as with the advertising of any commercial product. There is no such thing as purely educational drug company promotion of its wares.

“ The AMA shares the community’s concern, and we urge doctors to remain at
arm’s length, as much as possible, from the drug industry’s marketing
strategies. It is the AMA’s view that a doctor accepting cash or gifts
or travel from drug companies in return for prescribing a particular
medication must be reported.”

Wrong Dr Haikerwal: it is clear from your defence of expensive dinners for doctors paid for by drug companies, that you and the AMA are out of step with community sentiment on this matter.

“ The AMA is at the forefront of stamping out any real or perceived
unethical relationship between doctors and drug companies and we
actively promote greater transparency in dealings between doctors and
the pharmaceutical industry.”

Wrong Dr Haikerwal: The AMA, on your watch and previously, has responded to ‘any real or perceived
unethical relationship between doctors and drug companies’ in a defensive and reactionary manner.

“ An important fact that is missing from the recent media coverage is that
doctors do not receive any money for writing a prescription. “

Wrong Dr Haikerwal: Many medical consultations are purely to get a prescription and the patient/Medicare are charged accordingly. In theory the fee is for the consultation but in reality is for access to the prescription.

“ Their motivation is quality patient care, and that is reward enough.”

Wrong Dr Haikerwal: The idea that all doctors are pure and angelic is a load of rubbish.
Doctors are ordinary humans and the motivation for their behaviours is as complex a mixture of forces as it is for anyone else. Altruism, compassion, concern, competitiveness,laziness, bravery, cowardliness, intellectual curiosity, decency, envy, honesty, pride, arrogance, integrity, fear, avarice and greed all play their part.
The AMA is unlikely ever to take a realistic attitude to the human virtues and weaknesses of doctors as it has an essential a defender and promulgator of the myth of medical moral superiority.

“ There is no doubt that most doctors make the conscious effort to
prescribe in the best interests of the patient, not the best interests
of the marketer.”

The problem here Dr Haikerwal is not the ‘conscious decision’, but the unconscious influence and the mis-information which is the basis of the drug marketters advertising methods.

“ The media coverage of the relationship between drug companies and
doctors is doing some good in helping eliminate unethical and
unprofessional practice, but unfortunately it is also causing
considerable collateral damage to the image of the medical profession.”

Is Dr Haikerwal suggesting here that the truth should be hidden from the public so that inappropriate practices can continue unabated and undiscovered, simply in order to avoid some minor and justified damage to the image of the medical profession?

“So, a word of warning. Just consider the situation for patients if there
was no interface at all between the pharmaceutical industry and doctors.
Who would advise the drug companies on what patients need? How would
doctors know what new drugs would be available? Patients would be the
losers.”

Wrong wrong wrong Dr Haikerwal: Patients are the big losers under the current system. Patients would be the winners if the current undesirable situation were replaced by an appropriate program of independant post-graduate regular educational updates, unconnected to the drug marketing industry and paid for by a combination of the doctors and government through independant educational insitutions. This is what the AMA should be pushing for, not acting as a de facto PR company for the drug marketing industry as it is currently doing.

Full text:

Doctors have patient’s interests at heart

http://www.theage.com.au/news/opinion/doctors-have-patients-interests-at-heart/2006/08/10/1154803025195.html?page=fullpage#contentSwap1

Mukesh Haikerwal
August 11, 2006

AMID the debate about the relationship between pharmaceutical companies
and doctors, one vital issue is being overlooked: what’s best for the
patient.

The medical profession is aware that the marketing strategies of the
pharmaceutical industry have the potential to influence doctors’
prescribing behaviour, but doctors generally manage this influence well
and prescribe the medication, if needed, that is in the best interests
of the patient.

As long as human beings continue to get sick, we will need drugs, we
will need drug companies to produce and supply those drugs, and we will
need doctors to examine patients to determine the appropriate drug for
those patients.

New drugs come onto the market all the time and doctors need to learn
about them.

Doctors know that pharmaceutical company promotional material focuses on
the positives of their products but we are uniquely qualified to make
educated inquiries about the claimed benefits, and we are discerning
about the medications we prescribe.

At the moment, most drug education for a particular drug is provided by
the company that manufactures that drug. Therein lies the problem. The
drug companies are well placed to provide the medical education for
their products, but when is the line crossed from pure education to
prescribing influence or inducement?

The AMA shares the community’s concern, and we urge doctors to remain at
arm’s length, as much as possible, from the drug industry’s marketing
strategies. It is the AMA’s view that a doctor accepting cash or gifts
or travel from drug companies in return for prescribing a particular
medication must be reported.

At the same time, though, we have to ensure that the best possible
information about a new life-saving or life-enhancing drug is conveyed
to doctors.

The AMA is at the forefront of stamping out any real or perceived
unethical relationship between doctors and drug companies and we
actively promote greater transparency in dealings between doctors and
the pharmaceutical industry.

We support the Medicines Australia Code of Conduct. The expectation is
that whenever doctors are contacted by the pharmaceutical industry the
interaction is in keeping with the requirements of the code.

We have an AMA position paper that guides our members on appropriate
behaviour in their relationship with pharmaceutical companies. The
doctor’s role is very clearly to advocate for patients to get the right
medication for their condition in a timely manner at an affordable cost
with minimal co-payments.

And we have the AMA Code of Ethics, which many doctors have displayed on
the walls of their surgeries. All these AMA policy positions have a
simple but strong message: the patient must always come first.

An important fact that is missing from the recent media coverage is that
doctors do not receive any money for writing a prescription. Their
motivation is quality patient care, and that is reward enough.

You must remember, also, that the final word on what drug is dispensed
does not, in most cases, rest with the doctor.

There is a box on the prescription form that specifies if a brand drug
is to be dispensed or not. If the box is ticked, then the expectation is
that the brand drug will be dispensed. If not, a generic could be
dispensed. In more than 90 per cent of cases, the box is not ticked by
doctors.

That’s not to say that there are no efforts to influence how doctors may
prescribe. There is marketing material flooding into surgeries daily.

There is no doubt that most doctors make the conscious effort to
prescribe in the best interests of the patient, not the best interests
of the marketer.

The media coverage of the relationship between drug companies and
doctors is doing some good in helping eliminate unethical and
unprofessional practice, but unfortunately it is also causing
considerable collateral damage to the image of the medical profession.

So, a word of warning. Just consider the situation for patients if there
was no interface at all between the pharmaceutical industry and doctors.
Who would advise the drug companies on what patients need? How would
doctors know what new drugs would be available? Patients would be the
losers.

The challenge is to fund the wide range of educational activities
necessary to maintain quality patient care while, at the same time,
ensuring doctors remain independent of outside influences and always
prescribe in the best interests of their patients.

Dr Mukesh Haikerwal is president of the Australian Medical Association.