Healthy Skepticism Library item: 904

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

Schafer A.
Can your doctor be bought for a dinner?
2005 Mar 14

Full text:

Three years ago, the U.S. drug industry promised to end the practice of lavishing gifts on doctors. The Canadian drug industry has now decided to follow this lead. However, dramatic testimony earlier this month before the U.S. Senate reveals that despite guidelines, Big Pharma continues to invite doctors to exotic resorts, all expenses paid.

If you’re like most people, you don’t much care whether your doctor is treated to free travel. You’re confident that she would always put your interests first, ahead of any material benefits she might derive from prescribing the company’s drugs. Your doctor is similarly convinced of her own rectitude and bristles at the suggestion that her professional judgment could be influenced by company gifts. Whether the gifts are trinkets such as pens, or tickets to watch the Blue Jays, she’s confident that she would never alter her prescribing choices in order to curry drug-company favour. Even free travel wouldn’t bias her judgment: “I can’t be bought for a trip to Paris,” she’ll insist.

So, if doctors, patients and drug companies are all happy, do we need new guidelines to restrict expensive gifts to individual physicians? Actually, we need even stricter guidelines. Empirical evidence shows that both doctors and patients are naive in their assessment of the potential of gifts to create bias. Drug companies employ the world’s most sophisticated marketing experts. What they understand is that even apparently trivial gifts can influence doctors’ judgment and, subsequently, their behaviour. If pharmaceutical companies spend millions of promotional dollars distributing trinkets to docs, it’s because this investment pays big-time dividends in increased sales.

Of course, very few doctors intentionally prescribe inappropriate or inferior drugs for their patients. But studies demonstrate clearly that when doctors have been treated to a round of golf or a fine dinner, they’re much more likely to prescribe the products of the company that picked up the tab, even when scientific evidence points in a different direction.

Doctors half-recognize this moral problem. One recent study showed that more than 80 per cent of medical residents surveyed recognized that their colleagues were inappropriately influenced by industry promotions. With exquisite self-deception, however, 61-per-cent denied that their own practice was in any way influenced. That is, doctors can see the dangers of bias in their colleagues’ judgment, even when they are purblind to the danger of their own judgment being compromised.

Physician bias is almost always unconscious and unintentional, but its effect is morally insidious because it can easily result in serious harm to patients. To honour their vow (“The life and health of my patient will be my first consideration”), doctors must conscientiously avoid making themselves beholden to companies, whose raison d‘être, profitability, is potentially at odds with the needs of patients.

Here’s a non-medical example of how conflicts of interest can unconsciously bias one’s judgment. When volunteer research subjects are invited to divide money between themselves and another person, their notion of fairness is highly plastic. Subjects told that they had worked more productively than the other person quickly decide that they deserve more pay. After all, they reason, those who work better deserve greater reward. But when subjects are informed that the other person has worked more productively, then the subjects are drawn strongly to the view that equal distribution is fairest. In other words, the manner in which individuals see the world tends to be influenced, unconsciously, by their self-interest.

Self-interest isn’t the only biasing factor at play when doctors accept gifts. Much of social life is based upon reciprocity. When we accept gifts, we make ourselves beholden to the giver. The need to return kindness for kindness is a basic motivator in every human society. Thus, every gift from a drug rep to your doctor comes with strings attached — strings that undermine her professional commitment.

Under pressure from critics, the Canadian drug industry is modifying its code of conduct to permit only modest gifts. We know, however, that voluntary codes have failed in the United States. Clearly, something tougher is needed. We need the Canadian medical profession to bite the hand that feeds it, by requiring that its members buy their own meals and pay for their own green fees and travel. Otherwise, the moral cost is too high.