The Pharmaceutical Industry Influences Practice and Guidelines
BY Larry Hand
September 14, 2012
Dr. Pinna comments about the implication of this article so that the reader has a realistic
background to the article…
Dr. Pinna says…
The American Drug Industry is the most profitable industry
in the USA!
The big name drug stocks are as valuable as U.S.
Perhaps more valuable. They continue to grow in
value whilst U.S. Government bonds may ultimately default.
Why is Big Pharma so powerful?
Because they have a captive audience composed
of illiterate and frightened idiots known as “The
Why are they “Captive?”
Because when they get sick, or think they are sick,
they must go to a licensed physician who will then sell
them some pills.
Most patients love and trust their doctors.
And most doctors love their patients.
They look upon their patients as a parent looks at
his children. They need help, and you have a sincere desire
to help them.
In this cozy natural arrangement Big Pharma steps
in and starts to rob.
Medicine is such a complex area that almost every
doctor is never totally sure of what he is doing.
We know that the science of medicine is constantly
There is an old saying medicine: “What you know for
certain today will be totally wrong in fifteen years!”
With this background in place, the greedy pharmaceutical
companies start their process of making huge products.
They invent or buy new drugs. They then have to sell them to
the captive audience.
The way to do this is through the prescription writer,
They know that the doctor is insecure in his knowledge.
He longs for someone to tell him what exactly is the best
treatment for his patients.
The drug companies then send in people known as
“Drug Reps” who are trained to enlighten the doctor.
They come with charts and diagrams and models
and a long arguments that cover any question the doctor
These people are well trained actors with a background
About thirty years ago when I first started practicing
in the ER, the “Drug Reps” were almost always Pharmacists.
They were intelligent well educated men with a strong
background and experience in pharmacology.
We doctors would listen to them and ask questions
and their answers were erudite and supported by good
We respected their opinion and generally followed
As time went on the Pharmacists disappeared–
perhaps because they made more money in pharmacies
or perhaps the drug companies wanted less expensive
The Pharmacists were at first replaced by trained
male actors. These men answered the questions most
of the time, but they commanded little respect from the
“He’s just a “Drug Rep” was the common description
for them. Meaning, the “Drug Rep” is a phony salesman.
When the Drug Industry saw themselves losing sales
they hired very attractive women as “Drug Reps.”
Younger male doctors were very impressed by these
They were not only attractive; they were intelligent,
well educated and trained in pharmacology.
These ladies made the male reps appear worse than
All the reps knew how to handle the staff as well as
the doctor. They came with gifts for the receptionists,
the nurses and all auxiliary help.
For the doctor, they had charts, print outs and tons
In addition to the reps, the drug companies arranged
for dinners at the best restaurants in the area. The doctor
could bring his spouse or family or friends. A lecture on
medical problems would be part of the dinner so that the
doctor would receive continuing medical education
credit and the drug company could write off the expense
as a sales and educational cost.
This type of marketing was so successful that
eventually doctors had to stop seeing the reps or they
couldn’t see their patients.
Today, every licensed doctor is deluged with sales
pitches from every drug company on the planet. The
pitches come in the mail, the email, over the telephone
and in person.
We can see in the following article, that doctors
are no longer in control their own prescribing.
The drug companies are in control and the patients
and their insurance companies are paying for everything.
The worst part of this scenario is that the practice
of medicine and the health of the patients is ignored
in order to make profits for the drug companies.
That is why the USA is 37th. in the world in its
level of good health care.
People are dying as the drug companies get richer.
This must be changed!
But who will do it?
THE ARTICLE FROM MEDSCAPE
Individuals with financial conflicts should be excluded from involvement with medical practice guideline writing, regardless of disclosure, and physicians should be discouraged from meeting with drug company representatives, according to an article published in the September/October issue of the Annals of Family Medicine.
Linda M. Hunt, PhD, from the Department of Anthropology, Michigan State University, East Lansing, and colleagues analyzed the management of patients with type 2 diabetes and hypertension in 44 primary care centers in Michigan during 2009 and 2010. They conducted interviews with 58 physicians, nurse practitioners, and physician assistants, observed 107 clinical consultations with 12 clinicians in 6 clinics, and interviewed 70 patients treated by those 12 clinicians.
Sixty-two (89%) of the patients said they took multiple medications, with 36 (51%) of the 70 taking 5 or more medications, which is a threshold commonly used to define polypharmacy. Such medication use reflects a US trend of prescription drug use that has increased 6-fold since 1990. Adverse drug reactions reported by the Food and Drug Administration tripled between 1995 and 2005, the researchers write. In addition, lower diagnostic guideline criteria introduced over the years has resulted in an increase in the number of people diagnosed with and being treated for chronic diseases such as diabetes and hypertension, and even prediabetes, they write.
“We noted a common scenario: patients began medications after having moderately elevated test results (often at levels considered normal just a few years ago), developed additional symptoms, were found to have values falling outside reference ranges on other tests, and were prescribed more drugs,” the researchers write. “They were expected to continue these medications permanently: their target laboratory levels could be achieved only through continued use of these drugs.”
The clinical consultations the researchers observed “focused heavily on” medication prescriptions with little or no discussion of other treatment paths including diet and exercise, the authors write.
Of the 58 clinicians involved, 39 (67%) said they relied on clinical guidelines when prescribing, and only 4 (7%) questioned the clinical soundness of guidelines. All clinicians reported prescribing combinations of at least 2 drugs for hypertension or diabetes, and 25 (43%) often combined 3 or more drugs. “Furthermore, once a patient has a diabetes diagnosis, the goal numbers for hypertension and cholesterol are lower, so additional medications will be prescribed, quickly multiplying prescriptions,” the researchers write, saying this illustrates a so-called “prescribing cascade.”
Heavy Marketing by Pharmaceutical Companies
The authors also note that clinicians are exposed to heavy marketing efforts by pharmaceutical companies, and that this, combined with pay-for-performance programs, may be contributing to the emphasis on medication prescriptions. Of the 53 clinicians willing to discuss pharmaceutical marketing, 38 (72%) reported having regular contacts with pharmaceutical representatives, with 33 (62%) of these clinicians seeing 10 representatives weekly and 41 (77%) finding the representatives’ information useful.
The 70 patients in this study were taking an average of 4.8 medications, with 42 (60%) taking medications for disorders in addition to hypertension or diabetes, and 24 (57%) of those patients “taking additional medications for respiratory or gastric symptoms — well-known adverse effects of hypertension and diabetes medications,” the researchers write. Almost 70% (47) of the patients said they had experienced symptoms of adverse drug reactions from diabetes or hypertension medications, yet all but 1 physician in the study mentioned prescribing fewer drugs, most concentrating on either adding or changing prescriptions.
Patients also voiced many concerns about affordability of such medication prescriptions.
In addition to influencing clinicians’ decisions, pharmaceutical companies may also have influence on the establishment of guidelines physicians consult when making medication decisions, the researchers write. “[T]he committees and organizations setting the standards often have substantial pharmaceutical industry support and include many individuals with industry ties,” the researchers write.
At a minimum, they write, such industry-tied individuals should be excluded from guideline writing, physicians should be discouraged from seeing industry representatives, and pay-for-performance programs should be monitored for “evidence of unintended negative effects on patients.”